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Medical Coding And Billing Clinical Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
  • If you are not ready to take this test, you can study here.
  • Match each statement with the correct term.
  • Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






2. Verbal or written agreement that gives approval to some action - situation - or statement.






3. Approval or consent by a primary physician for patient referral to ancillary services and specialists






4. Verbal or written agreement that gives approval to some action - situation - or statement.






5. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






6. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






7. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






8. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






9. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






10. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






11. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






12. A health insurance enrollee chooses to see an out of network provider without authorization






13. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






14. A rule - condition - or requirement






15. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






16. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






17. A clinic that is owned by the HMO and the physicians are employees of the HMO






18. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






19. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






20. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






21. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






22. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






23. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






24. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






25. A patient claim is eligible for medicare and medicaid






26. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






27. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






28. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






29. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






30. A privileged communication that may be disclosed only with the patient's permission.






31. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






32. Approval or consent by a primary physician for patient referral to ancillary services and specialists






33. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






34. Medicare's method of paying acute care hospitals for inpatient care






35. A review of the need for inpatient hospital care - completed before the actual admission






36. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






37. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






38. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






39. Is the provider who renders a service to a patient






40. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






41. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






42. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






43. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






44. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






45. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






46. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






47. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






48. Customs - rules of conduct - courtesy - and manners of the medical profession






49. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






50. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost