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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. 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






2. 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






3. A rule - condition - or requirement






4. 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.






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






6. 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






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






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






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






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






11. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






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






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






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






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






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






18. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






19. 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






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






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






22. 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






23. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






24. American Medical Association






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






26. Billing for services not performed






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






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






29. 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






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






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






32. Billing for services not performed






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






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






35. 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.






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






37. 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






38. 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.






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






40. 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






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






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






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






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






45. 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






46. 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






47. 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






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






49. American Medical Association






50. 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