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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. Unauthorized release of information






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






3. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






4. Billing for services not performed






5. 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






6. 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






7. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






8. 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






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






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






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






12. 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






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






14. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






15. A rule - condition - or requirement






16. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






17. 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.






18. 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






19. Individually identifiable health information






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






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






22. 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






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






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






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

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






27. 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.






28. A patient claim is eligible for medicare and medicaid






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






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






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






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






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






34. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






35. 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






36. 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.






37. A patient claim is eligible for medicare and medicaid






38. 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






39. 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






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






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






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






43. 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






44. Approval or consent by a primary physician for patient referral to ancillary services and specialists






45. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






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






48. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






49. 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






50. 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