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






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






3. Medical services provided on an outpatient basis






4. 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






5. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






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






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






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






10. 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






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






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






13. 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






14. 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.






15. 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






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






17. Unauthorized release of information






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






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






20. American Medical Association






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






22. 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






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






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






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






26. A privileged communication that may be disclosed only with the patient's permission.






27. 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






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






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






30. 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






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






32. Health Information Portability and Accountability Act






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






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






35. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






36. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






37. 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






38. A nonprofit integrated delivery system






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






40. 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






41. American Medical Association






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






43. 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






44. 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






45. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






46. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






47. 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






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

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






50. 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