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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. 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






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






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






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






5. 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






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






7. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






10. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






11. What the insurance company will consider paying for as defined in the contract.






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






13. 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






14. A health insurance enrollee chooses to see an out of network provider without authorization






15. 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






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






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






18. 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






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






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






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






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






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






24. Billing for services not performed






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






26. 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






27. 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






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






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






30. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






31. 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






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






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






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






35. 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)






36. 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






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






38. 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






39. 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






40. 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.






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






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






43. 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.






44. 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.






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






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






47. 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)






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






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






50. 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.