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






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






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






5. 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






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






7. Medical services provided on an outpatient basis






8. 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






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






10. Unauthorized release of information






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






12. 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






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






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






15. 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






16. 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






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






18. Health Information Portability and Accountability Act






19. A patient claim is eligible for medicare and medicaid






20. 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






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






22. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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 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






25. 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.






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






27. 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.






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






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






30. 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






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. 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)






33. 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






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






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






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






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






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






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






40. 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






41. 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






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






43. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






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






47. The condition of being secluded from the presence or view of others.






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






49. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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