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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 structure for classifying outpatient services and procedures for purpose of payment






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






3. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






4. 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






5. 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






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






7. 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.






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






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






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






11. 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






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






13. Health Information Portability and Accountability Act






14. Medical services provided on an outpatient basis






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






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






17. 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






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






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






20. 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






21. 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






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






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






24. 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






25. 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






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






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






28. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






29. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






31. 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.






32. 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






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






34. 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






35. 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






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






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






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






39. The transmission of information between two parties to carry out financial or administrative activities related to health care.






40. 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






41. 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.






42. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






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






44. 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.






45. A rule - condition - or requirement






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






47. A nonprofit integrated delivery system






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






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






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