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






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






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






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






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






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






7. 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






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






9. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






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






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






14. 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






15. 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






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






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






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






19. A health insurance enrollee chooses to see an out of network provider without authorization






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






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






22. 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






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






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






25. 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






26. 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.






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






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






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






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






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






33. 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.






34. 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






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






36. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






37. 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






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






39. A nonprofit integrated delivery system






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






41. 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






42. 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






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






44. 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






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






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






47. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






48. 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.






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






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