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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 rule - condition - or requirement






2. 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






3. American Medical Association






4. 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






5. 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






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






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






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






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






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






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






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






13. 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.






14. 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






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






17. 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






18. 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






19. Individually identifiable health information






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






21. 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.






22. 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






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






24. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






25. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






26. 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






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






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






29. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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






31. 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






32. 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






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






34. 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






35. 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






36. Health Information Portability and Accountability Act






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. 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






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






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






41. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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






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






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






45. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






46. A patient claim is eligible for medicare and medicaid






47. 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






48. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






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






50. 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