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






2. A willful act by an employee of taking possession of an employer's money






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






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






5. 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






6. 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.






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






8. 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.






9. Unauthorized release of information






10. American Medical Association






11. 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






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






13. 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






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






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






16. Medical services provided on an outpatient basis






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






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






19. 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






20. 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






21. 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






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






23. 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






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






25. 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






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






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






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






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






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






31. 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






32. 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






33. 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






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






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






36. 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






37. 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






38. 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






39. 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






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






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






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






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






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






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






46. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






47. 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






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






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






50. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment