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






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






3. 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






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






5. American Medical Association






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






7. A health insurance enrollee chooses to see an out of network provider without authorization






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






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






10. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






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






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






13. Integrating benefits payable under more than one health insurance.






14. Individually identifiable health information






15. Individually identifiable health information






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






17. Medical services provided on an outpatient basis






18. A health insurance enrollee chooses to see an out of network provider without authorization






19. 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.






20. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






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






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






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






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






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






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






28. 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






29. A rule - condition - or requirement






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






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






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






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






34. 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.






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






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






37. 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






38. 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






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






40. 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






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 rule - condition - or requirement






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






44. 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






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






46. A nonprofit integrated delivery system






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. Customs - rules of conduct - courtesy - and manners of the medical profession






49. 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






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