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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 health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






3. Billing for services not performed






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






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






6. A rule - condition - or requirement






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






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






9. 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.






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






11. 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






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






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






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






15. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






17. 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.






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






19. 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






20. 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






21. 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






22. 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






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






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






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






26. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






28. 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






29. 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






30. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






32. 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






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






34. 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






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






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






37. 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






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






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






40. 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






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






42. 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)






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. 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






45. 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






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






47. A nonprofit integrated delivery system






48. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






49. A patient claim is eligible for medicare and medicaid






50. A patient claim is eligible for medicare and medicaid