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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 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.






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






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

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4. 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.






5. 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






6. 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.






7. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






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






10. 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






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






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






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






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






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






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






17. 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






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






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






20. American Medical Association






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






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






23. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






25. 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.






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






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






28. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






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






31. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






32. 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






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






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






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






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






37. Unauthorized release of information






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






39. 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






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






41. 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.






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






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






44. 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






45. 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






46. 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






47. 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






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






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






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.