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






2. 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






3. 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






4. 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.






5. Individually identifiable health information






6. Billing for services not performed






7. Health Information Portability and Accountability Act






8. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






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






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






12. 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






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






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






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






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






17. 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.






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






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






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






21. 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.






22. 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)






23. 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






24. 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






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






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






27. 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






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






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






30. 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






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






32. 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






33. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






34. 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






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






36. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






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






38. 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






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






40. 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.






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






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






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






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






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






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






47. American Medical Association






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






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






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