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






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






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






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






5. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






6. 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






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






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






9. 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






10. 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






11. 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






12. 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






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






14. Health Information Portability and Accountability Act






15. 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.






16. Unauthorized release of information






17. 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






18. 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.






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






20. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






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






22. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






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 flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






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






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






28. 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






29. 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






30. Unauthorized release of information






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






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






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






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






35. A nonprofit integrated delivery system






36. 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.






37. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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

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






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






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






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






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






44. 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






45. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






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






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






49. Individually identifiable health information






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







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