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






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






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






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






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






6. 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






7. 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






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






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






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






11. 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






12. Unauthorized release of information






13. 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






14. 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






15. A patient claim is eligible for medicare and medicaid






16. 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






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






18. 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






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






20. 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






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






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






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






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






25. A nonprofit integrated delivery system






26. Health Information Portability and Accountability Act






27. 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






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






29. 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






30. 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






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






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






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






34. 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






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






36. 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






37. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






39. 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






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






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






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






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






44. 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






45. 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






46. 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.






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






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






49. 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.






50. 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