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






2. A willful act by an employee of taking possession of an employer's money






3. 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






4. 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






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






6. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






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






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






9. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






11. The dates of healthcare services were provided to the beneficiary






12. 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






13. A list of the amount to be paid by an insurance company for each procedure service






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






15. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






17. 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






18. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






19. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






20. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






21. 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






22. 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






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






24. 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






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






26. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






27. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






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






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






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






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






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






33. A nonprofit integrated delivery system






34. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






35. 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






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






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






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






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






40. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






41. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






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






43. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






44. American Medical Association






45. 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






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






47. 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.






48. 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.






49. Medical services provided on an outpatient basis






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