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






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






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






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






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






6. 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.






7. A patient claim is eligible for medicare and medicaid






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






9. 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






10. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






12. Unauthorized release of information






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






14. 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






15. 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.






16. 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.






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






18. 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






19. 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






20. 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.






21. 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






22. 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






23. 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






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

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25. American Medical Association






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






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






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






29. 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






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






31. 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.






32. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






33. Billing for services not performed






34. 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






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






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






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






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






40. 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






41. 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






42. 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






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






45. 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






46. A monthly fee paid by the insured for specific medical insurance coverage






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






48. 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






49. 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






50. Medical services provided on an outpatient basis