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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. 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






2. 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






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






4. A patient claim is eligible for medicare and medicaid






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






6. The period of time that payment for Medicare inpatient hospital benefits are available






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






8. 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






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






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






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






12. 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.






13. Billing for services not performed






14. American Medical Association






15. 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






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






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






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






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






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






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






22. A patient claim is eligible for medicare and medicaid






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






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






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






26. Individually identifiable health information






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






28. 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






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






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






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






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






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






34. 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.






35. 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






36. American Medical Association






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






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






39. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






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






41. 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.






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






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






44. 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






45. 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)






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






47. 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






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






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






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