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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. Integrating benefits payable under more than one health insurance.






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






3. 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






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






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






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






7. American Medical Association






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






9. 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






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






11. 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.






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






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






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






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






16. 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






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






18. 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.






19. 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.






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






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






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






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






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






26. 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






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






28. Individually identifiable health information






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






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






31. Billing for services not performed






32. 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






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






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






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






37. A rule - condition - or requirement






38. 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






39. 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.






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






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






42. A privileged communication that may be disclosed only with the patient's permission.






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






44. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






45. 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






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






47. 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






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






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






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







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