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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 rule - condition - or requirement






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






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

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4. 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






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






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






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






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






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






10. 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






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






12. 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






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






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






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






16. A rule - condition - or requirement






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






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






19. 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






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






21. Unauthorized release of information






22. 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






23. Health Information Portability and Accountability Act






24. 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.






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






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






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






28. 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






29. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






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






32. 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






33. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






34. A nonprofit integrated delivery system






35. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






36. 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)






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






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






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






40. 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






41. 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






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






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






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






45. 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






46. Billing for services not performed






47. 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






48. A patient claim is eligible for medicare and medicaid






49. 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.






50. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment