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






2. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






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






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






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






7. 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






8. American Medical Association






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






10. The transmission of information between two parties to carry out financial or administrative activities related to health care.






11. A privileged communication that may be disclosed only with the patient's permission.






12. A list of the amount to be paid by an insurance company for each procedure service






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






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






15. 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.






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






17. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






18. 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.






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






20. 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






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






22. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






24. 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






25. 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






26. Medical services provided on an outpatient basis






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






28. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






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






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






32. 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






33. Individually identifiable health information






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






35. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






36. A rule - condition - or requirement






37. 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.






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






39. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






40. 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






41. 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






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






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






44. 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






45. Billing for services not performed






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






47. 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.






48. 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






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






50. Billing for services not performed