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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 patient claim is eligible for medicare and medicaid






2. 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






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






4. 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






5. 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






6. 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






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






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






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






10. 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






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






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






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






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






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






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






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






19. A nonprofit integrated delivery system






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






21. Verbal or written agreement that gives approval to some action - situation - or statement.






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






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






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






25. 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.






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






27. 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






28. 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






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






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






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






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






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






34. 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.






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






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






37. Health Information Portability and Accountability Act






38. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






40. 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






41. Unauthorized release of information






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






43. 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






44. 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






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






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






47. 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






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






49. American Medical Association






50. 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.