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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






3. 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.






4. 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






5. American Medical Association






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






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






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






9. 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






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






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






12. 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






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






14. 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






15. 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






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






17. 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






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






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






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






21. An intentional misrepresentation of the facts to deceive or mislead another.






22. 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






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






24. 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






25. 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.






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






27. 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.






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






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






30. 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






31. 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






32. A rule - condition - or requirement






33. 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






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






35. 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






36. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






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






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






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






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






42. A rule - condition - or requirement






43. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






44. 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.






45. 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






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






47. Unauthorized release of information






48. 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






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






50. 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