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






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






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






4. Medical services provided on an outpatient basis






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






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






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






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






9. 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






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






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






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






13. 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)






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






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






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






17. 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






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






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






20. 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






21. 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.






22. 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






23. 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






24. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






25. 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)






26. 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






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






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






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






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






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






33. 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






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






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






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






37. 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






38. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






39. 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






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

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41. 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






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






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






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






45. 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






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






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






48. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






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