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






2. 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






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






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






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






6. 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.






7. 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.






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. 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






10. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






13. The condition of being secluded from the presence or view of others.






14. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






15. Medical services provided on an outpatient basis






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






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






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






19. 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






20. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






21. Medical services provided on an outpatient basis






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






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






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






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






26. 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






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






28. 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.






29. 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






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






31. A patient claim is eligible for medicare and medicaid






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






33. 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






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






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






36. 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






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






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






39. A nonprofit integrated delivery system






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






41. 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






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






43. 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.






44. 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






45. 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






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






47. 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






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






49. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






50. Integrating benefits payable under more than one health insurance.