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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. 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






2. Billing for services not performed






3. 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






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






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






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






7. Unauthorized release of information






8. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






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






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






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

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13. 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






14. 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






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






16. A structure for classifying outpatient services and procedures for purpose of payment






17. 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






18. 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






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






20. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






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






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






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






25. Medical services provided on an outpatient basis






26. 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






27. 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






28. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






29. Individually identifiable health information






30. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






31. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






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






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






35. 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






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






37. 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






38. 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






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






40. What the insurance company will consider paying for as defined in the contract.






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






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






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






44. 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






45. 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.






46. 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






47. 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






48. Integrating benefits payable under more than one health insurance.






49. Unauthorized release of information






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