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






2. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






3. Health Information Portability and Accountability Act






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






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






6. 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






7. 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






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






9. 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






10. 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






11. 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






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






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






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






16. 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






17. A rule - condition - or requirement






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






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






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

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






22. Billing for services not performed






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






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






25. 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






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






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






28. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






29. 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






30. 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






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






32. American Medical Association






33. 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.






34. 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






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






36. 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






37. 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






38. 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.






39. Billing for services not performed






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






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






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






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






44. 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.






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






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






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






48. Medical services provided on an outpatient basis






49. 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






50. 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