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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 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.






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






3. 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






4. 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.






5. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






6. Health Information Portability and Accountability Act






7. 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






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






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






10. 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






11. 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






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






13. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






14. Individually identifiable health information






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






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






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






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






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






20. 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






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






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






23. 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






24. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






28. 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






29. 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






30. A rule - condition - or requirement






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






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






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

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34. A rule - condition - or requirement






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






36. Unauthorized release of information






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






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






39. Billing for services not performed






40. 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






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






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






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






44. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






45. 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






46. 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






47. 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






48. 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






49. Medical services provided on an outpatient basis






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