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






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






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






4. 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






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






6. A nonprofit integrated delivery system






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






8. 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






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






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






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






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






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






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






15. 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






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






17. 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






18. 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.






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






20. 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)






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






22. 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






23. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






24. 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






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






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






27. 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






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






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






30. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






31. 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






32. American Medical Association






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






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






35. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






36. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






37. 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.






38. Unauthorized release of information






39. Health Information Portability and Accountability Act






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






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






42. Unauthorized release of information






43. 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






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






45. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






46. 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






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






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






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






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