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






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






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






4. 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






5. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






6. Unauthorized release of information






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






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

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






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






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






12. Is the provider who renders a service to a patient






13. 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






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






15. 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






16. 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






17. 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






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

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19. 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






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






21. 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.






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






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






24. 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






25. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






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






27. Individually identifiable health information






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






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






30. 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






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






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






33. Unauthorized release of information






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






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






36. Medical services provided on an outpatient basis






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






38. 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






39. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






40. 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






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






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






43. 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)






44. 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






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






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






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. 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






49. 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






50. 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