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






2. 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






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






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






5. The condition of being secluded from the presence or view of others.






6. 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.






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






8. 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






9. 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.






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






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






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






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






14. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






16. 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






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






18. 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.






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. American Medical Association






21. A nonprofit integrated delivery system






22. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






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






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






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






27. 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.






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






29. 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






30. 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






31. American Medical Association






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






33. A nonprofit integrated delivery system






34. 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






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






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






37. 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)






38. 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






39. 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






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






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






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






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






44. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






45. Medical services provided on an outpatient basis






46. 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






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






48. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






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