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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. 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






2. 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.






3. Unauthorized release of information






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






5. 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






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






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






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






9. Billing for services not performed






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






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






13. 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.






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

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15. 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






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






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






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






19. A nonprofit integrated delivery system






20. Individually identifiable health information






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






22. 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






23. A clinic that is owned by the HMO and the physicians are employees of the HMO






24. 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.






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






26. A patient claim is eligible for medicare and medicaid






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






29. 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






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






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






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






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






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






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






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






37. 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.






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






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






40. American Medical Association






41. Individually identifiable health information






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






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






44. 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






45. 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






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






47. Health Information Portability and Accountability Act






48. Medical services provided on an outpatient basis






49. A patient claim is eligible for medicare and medicaid






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