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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 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






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






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






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






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






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






7. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






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






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






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






12. 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






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






14. 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






15. An intentional misrepresentation of the facts to deceive or mislead another.






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






17. 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






18. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






19. What the insurance company will consider paying for as defined in the contract.






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






21. A list of the amount to be paid by an insurance company for each procedure service






22. American Medical Association






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






24. 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.






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






26. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






27. 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






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

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29. A nonprofit integrated delivery system






30. 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






31. Health Information Portability and Accountability Act






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






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






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






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






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






37. 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






38. Medical services provided on an outpatient basis






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






40. American Medical Association






41. 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






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






44. What the insurance company will consider paying for as defined in the contract.






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






46. 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.






47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






48. 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






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






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