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






2. 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






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






4. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






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






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






8. 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.






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






10. 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.






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






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






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






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






15. 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






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






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






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






19. 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






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






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






22. American Medical Association






23. 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






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






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






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






27. 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






28. 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






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






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






31. 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






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






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






34. 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






35. 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.






36. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






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






39. 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.






40. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






42. 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






43. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






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






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 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






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






48. 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.






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






50. Health Information Portability and Accountability Act