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






2. A nonprofit integrated delivery system






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






4. Medical services provided on an outpatient basis






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






6. 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






7. Health Information Portability and Accountability Act






8. 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






9. American Medical Association






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






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






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






13. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






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






17. 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






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






19. 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






20. 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.






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






22. 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






23. 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






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






25. 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






26. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






27. 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.






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






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






30. A patient claim is eligible for medicare and medicaid






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






32. A structure for classifying outpatient services and procedures for purpose of payment






33. 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






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






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






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






37. A structure for classifying outpatient services and procedures for purpose of payment






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






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






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






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






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






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






44. 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






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






46. Health Information Portability and Accountability Act






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






48. 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






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






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







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