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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. Health Information Portability and Accountability Act






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






3. 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






4. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






5. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






6. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






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






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






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






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






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






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






13. 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






14. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






16. A nonprofit integrated delivery system






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






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. 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






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






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






22. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






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






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






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






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






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






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






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






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






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

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






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






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






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






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






37. 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






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






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






40. 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






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






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






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






44. 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






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






47. 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






48. 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






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






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