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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. 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






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






3. 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






4. 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.






5. 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






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






7. 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.






8. The dates of healthcare services were provided to the beneficiary






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






10. 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






11. 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






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






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






14. 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.






15. 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






16. 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






17. A review of the need for inpatient hospital care - completed before the actual admission






18. 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






19. 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






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






21. 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






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






23. 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






24. 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






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

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26. 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.






27. 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






28. 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.






29. 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






30. 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






31. 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.






32. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






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






34. 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






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






36. 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






37. 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






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






39. 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






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






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






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






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






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






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






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






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






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






49. Medical services provided on an outpatient basis






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

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