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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. 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






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






3. 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.






4. 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






5. 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






6. 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






7. 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.






8. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






9. 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






10. 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






11. 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






12. 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






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






14. 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.






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. Integrating benefits payable under more than one health insurance.






18. 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.






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






20. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






21. 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






22. 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






23. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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






25. 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






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






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






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






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






30. 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






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






32. 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






33. 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






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






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






36. 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






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






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






39. Medical services provided on an outpatient basis






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






41. 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






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






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






44. 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






45. 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






46. Individually identifiable health information






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






48. 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






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






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