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






2. 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






3. 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






4. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






5. American Medical Association






6. 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.






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






8. 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






9. A patient claim is eligible for medicare and medicaid






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






11. 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






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






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






14. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






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






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






17. 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






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






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






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






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






22. 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






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






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






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






26. 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.






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






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






29. A rule - condition - or requirement






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






31. 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






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






33. American Medical Association






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






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






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. The maximum amount a plan pays for a covered service






38. A rule - condition - or requirement






39. 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






40. An organization of provider sites with a contracted relationship that offer services






41. Individually identifiable health information






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






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






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






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






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






47. 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






48. 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






49. 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.






50. 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.