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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 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.






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






4. 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






5. 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






6. A patient claim is eligible for medicare and medicaid






7. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






8. 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






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






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






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






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






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






14. A willful act by an employee of taking possession of an employer's money






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






16. 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.






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






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






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






20. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






22. 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.






23. The maximum amount a plan pays for a covered service






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






25. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






26. 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






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






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






29. 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






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

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






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






33. 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






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






35. 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






36. An organization of provider sites with a contracted relationship that offer services






37. 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






38. An organization of provider sites with a contracted relationship that offer services






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






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






41. 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






42. 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






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






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






45. Unauthorized release of information






46. 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






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






48. Billing for services not performed






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






50. A monthly fee paid by the insured for specific medical insurance coverage