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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 amount of actual money available to the medical practice






2. 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.






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






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






5. 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






6. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






9. 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.






10. A provision that apples when a person is covered under more than one group medical program






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






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






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






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






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






16. 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






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






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






19. 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






20. 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






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






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






23. 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)






24. A nonprofit integrated delivery system






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






26. Someone who is eligible for or receiving benefits under an insurance policy or plan






27. 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






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






29. 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






30. Unauthorized release of information






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






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






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






34. A provision that apples when a person is covered under more than one group medical program






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






36. 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






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






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






39. A rule - condition - or requirement






40. A nonprofit integrated delivery system






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






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






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






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






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. 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






47. 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






48. 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






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






50. 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.