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






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






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






4. 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






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






6. Individually identifiable health information






7. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






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






9. 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






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






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






12. 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






13. 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






14. 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.






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






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






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






18. 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






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






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






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






22. A rule - condition - or requirement






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






24. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






26. 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






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






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






29. 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






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






31. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






32. Health Information Portability and Accountability Act






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






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






35. 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






36. Medical services provided on an outpatient basis






37. Medical services provided on an outpatient basis






38. 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






39. Standards of conduct generally accepted as a moral guide for behavior.






40. 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






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






42. A nonprofit integrated delivery system






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






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






45. 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






46. 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






47. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






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






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