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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. 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






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






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






5. 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.






6. 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






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






8. 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






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






10. 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.






11. Individually identifiable health information






12. 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






13. 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






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






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






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






17. 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






18. 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






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






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






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






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






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






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






25. 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






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






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






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






29. A rule - condition - or requirement






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






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






32. 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.






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

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






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






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






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






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






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






40. 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






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






42. A provision that apples when a person is covered under more than one group medical program






43. 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






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






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






46. 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)






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






48. 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






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






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







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