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






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






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






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






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






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






7. Health Information Portability and Accountability Act






8. 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.






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






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






11. 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






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






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






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






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






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






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






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






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






21. A patient claim is eligible for medicare and medicaid






22. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






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






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






25. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






26. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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






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






29. 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.






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






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






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






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






34. 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






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






36. 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






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






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






39. 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)






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






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






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






43. Billing for services not performed






44. A list of the amount to be paid by an insurance company for each procedure service






45. 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






46. 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






47. Medical services provided on an outpatient basis






48. 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






49. 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






50. 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