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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 specializes in a specific area of medicine - such as cardiology - oncology - urology






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






3. 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






4. 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






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






6. 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






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






8. 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






9. 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.






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






11. 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






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






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






14. 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






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






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






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






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






19. A nonprofit integrated delivery system






20. American Medical Association






21. 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






22. 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






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






25. 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






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






27. An intentional misrepresentation of the facts to deceive or mislead another.






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






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






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






31. A clinic that is owned by the HMO and the physicians are employees of the HMO






32. 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.






33. 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






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






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






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






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






38. Health Information Portability and Accountability Act






39. 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






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






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






42. 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






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






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






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






46. 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






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






48. A rule - condition - or requirement






49. 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.






50. Individually identifiable health information







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