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






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






3. Customs - rules of conduct - courtesy - and manners of the medical profession






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






5. 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






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






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






8. 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






9. 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






10. 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.






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






12. 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






13. 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






14. 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






15. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






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






17. 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






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






19. Medical services provided on an outpatient basis






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






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






22. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






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






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






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






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






28. 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)






29. 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






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






31. 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






32. 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






33. 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






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






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






36. 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.






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






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






39. 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






40. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






42. 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






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






44. 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






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






46. 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






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






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






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






50. 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