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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 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






2. A nonprofit integrated delivery system






3. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






4. Individually identifiable health information






5. 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






6. 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






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






8. 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






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






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






12. 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.






13. 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.






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






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






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






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






19. What the insurance company will consider paying for as defined in the contract.






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. 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






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






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






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

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






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






27. 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.






28. 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.






29. 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






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






31. 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.






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






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






34. 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






35. 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






36. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






38. 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






39. 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






40. 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






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






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






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






44. Billing for services not performed






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






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






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






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






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






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