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






2. 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.






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






4. 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






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






6. Billing for services not performed






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






8. A nonprofit integrated delivery system






9. 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






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






11. 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.






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






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






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






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






16. 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.






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






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






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






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






21. Unauthorized release of information






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






23. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






24. 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






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






26. The maximum amount a plan pays for a covered service






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






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






29. 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






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






31. A rule - condition - or requirement






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






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






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






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






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






37. 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






38. A nonprofit integrated delivery system






39. 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






40. 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






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






42. Individually identifiable health information






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






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






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






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






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






48. 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






49. 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.






50. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year