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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 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






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






3. 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






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






5. 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






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






7. 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.






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






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






10. 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






11. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






13. 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






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






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






16. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






17. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






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






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






20. 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






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






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






23. 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.






24. 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






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






26. American Medical Association






27. 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.






28. 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






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






30. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






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






32. 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






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






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






35. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






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






37. 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






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






39. 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






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






41. 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






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






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

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






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






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






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






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






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






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