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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. 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






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






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






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






5. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






6. 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.






7. The maximum amount a plan pays for a covered service






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






9. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






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






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






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






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

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15. 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






16. 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






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






18. 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.






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






20. 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






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






22. 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.






23. 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






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






25. 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






26. 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






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






28. Individually identifiable health information






29. A health insurance enrollee chooses to see an out of network provider without authorization






30. 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






31. A nonprofit integrated delivery system






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






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






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






35. 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






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






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. 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






39. 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






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






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






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. Health Information Portability and Accountability Act






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






45. 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






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






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






48. 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






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






50. American Medical Association