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






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






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






4. American Medical Association






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






6. 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






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






8. 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






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






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






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. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






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






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






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 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






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






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






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






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






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






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






24. 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






25. 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






26. A nonprofit integrated delivery system






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






28. A list of the amount to be paid by an insurance company for each procedure service






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






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






31. American Medical Association






32. 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.






33. 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






34. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






36. 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






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






38. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






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






40. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






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






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






46. 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






47. 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.






48. 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






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






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