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






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






4. A patient claim is eligible for medicare and medicaid






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






6. 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






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






8. 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.






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






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






11. 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.






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






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






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






15. 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






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






17. Health Information Portability and Accountability Act






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






19. 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.






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






21. A nonprofit integrated delivery system






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






24. 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






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






26. 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






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






29. Billing for services not performed






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






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






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






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






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






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


36. 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






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






38. 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






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. 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.






41. Billing for services not performed






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






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. Individually identifiable health information






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






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






47. 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






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






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






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