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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. American Medical Association






2. Health Information Portability and Accountability Act






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






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






5. 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






6. 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






7. 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






8. Medical services provided on an outpatient basis






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






10. 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






11. 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






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






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






14. A nonprofit integrated delivery system






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 nonprofit integrated delivery system






17. 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






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






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






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






21. 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






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






23. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






24. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






25. 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






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






27. 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






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






29. The transmission of information between two parties to carry out financial or administrative activities related to health care.






30. American Medical Association






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






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






33. Unauthorized release of information






34. 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






35. 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






36. 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






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






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

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39. Is the provider who renders a service to a patient






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






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






42. 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






43. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






44. A provision that apples when a person is covered under more than one group medical program






45. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






46. 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






47. 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






48. The transmission of information between two parties to carry out financial or administrative activities related to health care.






49. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






50. Is the provider who renders a service to a patient