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






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






3. 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






4. 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






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






6. 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






7. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






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. American Medical Association






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






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






13. 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






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






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






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






17. 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.






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






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






20. 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.






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






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






23. 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






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






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






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






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






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






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






30. 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






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






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






33. 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






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






35. Medical services provided on an outpatient basis






36. 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.






37. 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






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






39. 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.






40. 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.






41. 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






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






43. 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






44. 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.






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






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






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






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






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






50. 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