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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. 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






3. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






4. Billing for services not performed






5. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






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






7. 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






8. Individually identifiable health information






9. The condition of being secluded from the presence or view of others.






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






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






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






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






14. 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.






15. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






16. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






17. Billing for services not performed






18. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






19. Someone who is eligible for or receiving benefits under an insurance policy or plan






20. American Medical Association






21. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






24. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






25. The transmission of information between two parties to carry out financial or administrative activities related to health care.






26. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






27. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






28. Standards of conduct generally accepted as a moral guide for behavior.






29. The maximum amount a plan pays for a covered service






30. 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.






31. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






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






33. 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






34. The amount of actual money available to the medical practice






35. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






36. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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37. A monthly fee paid by the insured for specific medical insurance coverage






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






39. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






40. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






41. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






42. An organization of provider sites with a contracted relationship that offer services






43. Medical staff member who is legally responsible for the care and treatment given to a patient.






44. The period of time that payment for Medicare inpatient hospital benefits are available






45. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






46. An intentional misrepresentation of the facts to deceive or mislead another.






47. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






49. 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.






50. 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