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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 intentional misrepresentation of the facts to deceive or mislead another.






2. 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






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






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






5. American Medical Association






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






7. 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






8. Unauthorized release of information






9. A patient claim is eligible for medicare and medicaid






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






11. 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






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






13. Individually identifiable health information






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






15. 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.






16. 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






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






18. 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






19. 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






20. 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






21. American Medical Association






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






23. 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






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






25. 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






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






27. 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






28. Medical services provided on an outpatient basis






29. 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






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






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






32. A rule - condition - or requirement






33. 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






34. 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






35. 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






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






37. 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






38. A nonprofit integrated delivery system






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






40. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






41. 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






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






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






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






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






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






48. 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.






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






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