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






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






3. 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






4. 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.






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






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






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






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






9. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






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






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






12. Individually identifiable health information






13. 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






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






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






16. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






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






20. 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






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






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






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






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






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






26. 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






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






28. 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






29. 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






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






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






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






33. 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






34. 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






35. Medical services provided on an outpatient basis






36. Billing for services not performed






37. 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






38. 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






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






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






41. American Medical Association






42. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






43. 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.






44. A patient claim is eligible for medicare and medicaid






45. A nonprofit integrated delivery system






46. 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






47. 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






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






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






50. Billing for services not performed