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






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






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






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






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






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






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






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






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






10. Medical services provided on an outpatient basis






11. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






12. 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






13. 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






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






15. 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






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






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






18. 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






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






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






21. 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






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






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






24. 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.






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. A rule - condition - or requirement






27. 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






28. 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






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






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






31. Medical services provided on an outpatient basis






32. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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






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






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






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






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






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






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






40. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






42. 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






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






44. A patient claim is eligible for medicare and medicaid






45. 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






46. 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






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






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






49. Unauthorized release of information






50. 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