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






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






3. 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






4. 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






5. 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






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






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






9. 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.






10. Medical services provided on an outpatient basis






11. A rule - condition - or requirement






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






13. 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.






14. 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.






15. A privileged communication that may be disclosed only with the patient's permission.






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






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






18. 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






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






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






21. 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.






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






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






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






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






26. 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.






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






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






29. Integrating benefits payable under more than one health insurance.






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






31. A privileged communication that may be disclosed only with the patient's permission.






32. American Medical Association






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






34. Medical services provided on an outpatient basis






35. 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






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






37. 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






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






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






40. 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






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






42. 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






43. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






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






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






46. Unauthorized release of information






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






48. 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






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. Someone who is eligible for or receiving benefits under an insurance policy or plan







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