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






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






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






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






5. 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






6. 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






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






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






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






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






11. American Medical Association






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






13. Health Information Portability and Accountability Act






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






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






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






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






18. Billing for services not performed






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






20. Medical services provided on an outpatient basis






21. 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






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






23. 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






24. 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






25. 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






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






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






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

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29. 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






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






31. 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






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






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






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






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






36. 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






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






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






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






40. 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






41. 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






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






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






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






45. 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






46. 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






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






48. 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.






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






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







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