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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 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






2. 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.






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






4. 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






5. 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






6. 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






7. 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






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






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






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






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






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






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






14. 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.






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






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






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






18. Health Information Portability and Accountability Act






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






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






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






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






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






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






25. 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






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






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






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






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






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






31. Medical services provided on an outpatient basis






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






33. 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






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






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






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






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






38. A rule - condition - or requirement






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






40. 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






41. American Medical Association






42. 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






43. 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






44. 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






45. Unauthorized release of information






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






47. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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


49. A patient claim is eligible for medicare and medicaid






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