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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. 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






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






3. 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






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






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






6. 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






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. 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






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






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






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






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






13. 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






14. Billing for services not performed






15. 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






16. A patient claim is eligible for medicare and medicaid






17. Medical services provided on an outpatient basis






18. 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.






19. 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






20. 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






21. A nonprofit integrated delivery system






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






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






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






25. 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






26. 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






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






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






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






30. 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






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






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






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






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






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






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






37. Standards of conduct generally accepted as a moral guide for behavior.






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






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. 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)






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






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






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






44. A rule - condition - or requirement






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






46. A patient claim is eligible for medicare and medicaid






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






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






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






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