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






2. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






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






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






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






7. 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






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






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






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






11. 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






12. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






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






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






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






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






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






19. 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






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

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






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






23. Individually identifiable health information






24. 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.






25. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






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






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






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






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






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






32. Is a provider who sends the patients for testing or treatment






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

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34. 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






35. Billing for services not performed






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






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






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






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






40. 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






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






42. Medical services provided on an outpatient basis






43. 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






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






45. 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.






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






47. 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






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






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






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