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






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. 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






4. 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






5. Unauthorized release of information






6. 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






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






8. Billing for services not performed






9. 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






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






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






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






13. 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.






14. A patient claim is eligible for medicare and medicaid






15. 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






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. 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






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






19. 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.






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






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






22. 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.






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






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






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






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






27. 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






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






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






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






31. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






33. 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)






34. 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






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






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






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






38. American Medical Association






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






40. 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






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






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






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






44. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






45. Standards of conduct generally accepted as a moral guide for behavior.






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






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






49. 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.






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