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






2. 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






3. 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






4. 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






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






6. 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






7. A patient claim is eligible for medicare and medicaid






8. 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






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






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






12. Billing for services not performed






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






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






15. 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






16. Medical services provided on an outpatient basis






17. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






18. A rule - condition - or requirement






19. 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






20. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






22. American Medical Association






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






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






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






26. The condition of being secluded from the presence or view of others.






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






28. 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






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






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






31. 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






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






33. 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






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






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






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






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






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






39. 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






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






41. 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.






42. 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






43. The dates of healthcare services were provided to the beneficiary






44. 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






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






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






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






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






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






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