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






2. 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






3. 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






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






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






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






7. 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






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






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






10. 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.






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






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






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






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






15. 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






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






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






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






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






20. Individually identifiable health information






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






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






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






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






25. The maximum amount a plan pays for a covered service






26. 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






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






28. 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






29. Billing for services not performed






30. 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






31. 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






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






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






34. 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






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






36. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






37. The maximum amount a plan pays for a covered service






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






39. 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






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






41. 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






42. 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






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






44. A provision that apples when a person is covered under more than one group medical program






45. 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.






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






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






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

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50. 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