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






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






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






4. 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






5. American Medical Association






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






7. 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






8. 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






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






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






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






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


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






14. 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






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






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






17. 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






18. 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






19. 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






20. 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






21. 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






22. 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






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






24. Health Information Portability and Accountability Act






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






26. Individually identifiable health information






27. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






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






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






30. The amount of actual money available to the medical practice






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






32. 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






33. Unauthorized release of information






34. 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






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






36. 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






37. 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.






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






39. 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.






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






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






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






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






44. 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






45. American Medical Association






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






47. 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






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






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






50. 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