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






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






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






4. 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.






5. 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.






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






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






8. 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






9. 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.






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






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






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






13. 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






14. Billing for services not performed






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






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






17. Health Information Portability and Accountability Act






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






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






20. 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






21. 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






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






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






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






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






26. American Medical Association






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






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






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






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






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






32. A health insurance enrollee chooses to see an out of network provider without authorization






33. 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)






34. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






36. 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






37. 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






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






39. 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






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






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






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






43. 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






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






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






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

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47. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






48. A nonprofit integrated delivery system






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






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