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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. 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






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






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






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






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






6. 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






7. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






8. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






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

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10. 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






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






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






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






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






15. Individually identifiable health information






16. 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






17. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






18. 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






19. 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






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






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






22. 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






23. A patient claim is eligible for medicare and medicaid






24. A rule - condition - or requirement






25. 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






26. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






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 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






29. 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






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






31. 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.






32. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






33. 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.






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






35. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






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






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






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






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






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






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






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






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






44. The period of time that payment for Medicare inpatient hospital benefits are available






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






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






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






48. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






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