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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 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






2. The condition of being secluded from the presence or view of others.






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






4. A rule - condition - or requirement






5. 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






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






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






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






9. 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.






10. 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






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






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






13. Billing for services not performed






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






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






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






17. 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)






18. 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






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






20. 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






21. 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






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. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






24. American Medical Association






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






26. 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






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






28. Unauthorized release of information






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






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






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






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






33. 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






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






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






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






37. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.


38. Individually identifiable health information






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






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






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






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






43. 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






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






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






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






47. 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






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






49. 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.






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