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






2. 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






3. A rule - condition - or requirement






4. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






5. 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.






6. 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






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






8. A patient claim is eligible for medicare and medicaid






9. 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






10. 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






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






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






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






14. 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.






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






16. American Medical Association






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






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






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






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






22. 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






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






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






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






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






27. 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






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






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






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






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






32. 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






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






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

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






36. 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






37. 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






38. 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






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






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






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






42. Medical services provided on an outpatient basis






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






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






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






46. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






47. 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






48. Unauthorized release of information






49. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






50. 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