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






3. 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






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






5. 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.






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






7. Billing for services not performed






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






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






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






11. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






12. 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






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

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14. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






15. Medical services provided on an outpatient basis






16. Is a provider who sends the patients for testing or treatment






17. 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






18. 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






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






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






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






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






23. A patient claim is eligible for medicare and medicaid






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






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






26. Unauthorized release of information






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






28. 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.






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






30. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






31. A rule - condition - or requirement






32. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






33. 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






34. Medical services provided on an outpatient basis






35. 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.






36. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






37. Health Information Portability and Accountability Act






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






39. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






41. 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






42. 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






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






44. 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






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






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






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






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






49. 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






50. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment