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






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






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






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






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






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






7. 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






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






9. Billing for services not performed






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






11. 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






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






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






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






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






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






17. 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






18. 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






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






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






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






22. 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






23. 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.






24. 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






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






26. 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






27. A patient claim is eligible for medicare and medicaid






28. 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






29. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






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






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






33. 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






34. 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






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






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






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






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






39. 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.






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






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






42. A privileged communication that may be disclosed only with the patient's permission.






43. 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






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






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






46. 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.






47. 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






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






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






50. 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