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






2. 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






3. 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






4. 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






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






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. Medical services provided on an outpatient basis






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






9. 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






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






11. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






12. 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






13. 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.






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






15. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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16. 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






17. A patient claim is eligible for medicare and medicaid






18. 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






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






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






21. 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.






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






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






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






25. 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






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






27. 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






28. 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






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






30. 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






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






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






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






34. A rule - condition - or requirement






35. 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.






36. 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)






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






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






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






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






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






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






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






44. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






45. 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






46. 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.






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






48. 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






49. 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






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