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






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






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






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






5. 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






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






7. 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.






8. 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






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






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

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11. 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






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






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






14. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






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






16. 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.






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






18. 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.






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






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






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






22. 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.






23. 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.






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






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






26. 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






27. 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






28. 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






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






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






31. A nonprofit integrated delivery system






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






33. 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






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






35. The dates of healthcare services were provided to the beneficiary






36. 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






37. 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






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






39. 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






40. 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






41. 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.






42. A nonprofit integrated delivery system






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






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






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






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






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






48. 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






49. 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






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