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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 intentional misrepresentation of the facts to deceive or mislead another.






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






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






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






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






7. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






8. 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






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






10. 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






11. A patient claim is eligible for medicare and medicaid






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






13. 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.






14. Unauthorized release of information






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






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


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






18. 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






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






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






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






22. 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






23. 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






24. 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.






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






26. 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






27. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






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






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






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






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






33. Health Information Portability and Accountability Act






34. 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






35. 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






36. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






37. A rule - condition - or requirement






38. Individually identifiable health information






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






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






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






42. 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)






43. 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






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






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






46. 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






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






48. A rule - condition - or requirement






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






50. 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