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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 structure for classifying outpatient services and procedures for purpose of payment






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






3. 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






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






5. 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)






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






7. 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






8. Integrating benefits payable under more than one health insurance.






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






11. American Medical Association






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






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






14. A review of the need for inpatient hospital care - completed before the actual admission






15. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






16. Health Information Portability and Accountability Act






17. 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






18. 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






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






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






21. 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.






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






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






24. 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






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






26. A clinic that is owned by the HMO and the physicians are employees of the HMO






27. A rule - condition - or requirement






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






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






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






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






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






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






35. 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






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






37. 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






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






39. 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






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






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






42. 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






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






44. 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






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






46. 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






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






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






49. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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