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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. 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






2. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






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






5. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






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






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






9. 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






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






11. 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






12. 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.






13. 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.






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






15. 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






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






17. 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






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






19. 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






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






21. Customs - rules of conduct - courtesy - and manners of the medical profession






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






23. 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






24. 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






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






26. A nonprofit integrated delivery system






27. A patient claim is eligible for medicare and medicaid






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






29. Health Information Portability and Accountability Act






30. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






31. 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






32. 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






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






34. 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






35. A patient claim is eligible for medicare and medicaid






36. 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






37. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






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






39. 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






40. 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






41. 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.






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






43. Is a provider who sends the patients for testing or treatment






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






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






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






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






49. Individually identifiable health information






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