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






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






3. 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






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






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






6. 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






7. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






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






10. A nonprofit integrated delivery system






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






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






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






14. 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






15. Billing for services not performed






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






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






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






19. 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.






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






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






22. 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






23. 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






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






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






26. 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






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






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






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






30. 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






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






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






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






34. 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






35. Individually identifiable health information






36. 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






37. 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






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






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






40. 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






41. The period of time that payment for Medicare inpatient hospital benefits are available






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






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






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






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






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






47. 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






48. 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.






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






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