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






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






3. 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






4. 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






5. 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






6. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






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






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






9. 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






10. American Medical Association






11. 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






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






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






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






15. 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






16. 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






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






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






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






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






21. 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






22. 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






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






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

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






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






28. 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






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






30. 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






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






32. Individually identifiable health information






33. 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






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






35. 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






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






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






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 health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






41. 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






42. 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






43. 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






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






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






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






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






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






49. 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.






50. American Medical Association