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






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






3. A clinic that is owned by the HMO and the physicians are employees of the HMO






4. Health Information Portability and Accountability Act






5. 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.






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






7. A nonprofit integrated delivery system






8. 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






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






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






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






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






14. 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






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






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






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






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. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






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. 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.






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






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






24. 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






25. Medical services provided on an outpatient basis






26. 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






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






28. 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






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






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






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






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






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






34. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






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






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






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






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






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

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41. A clinic that is owned by the HMO and the physicians are employees of the HMO






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






43. A patient claim is eligible for medicare and medicaid






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

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46. 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.






47. 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






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






49. Health Information Portability and Accountability Act






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