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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. 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






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






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. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






6. Health Information Portability and Accountability Act






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






8. 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






9. Unauthorized release of information






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






11. 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.






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






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






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






15. 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






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






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






18. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






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






20. 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






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






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






23. 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






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






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






26. Medical staff member who is legally responsible for the care and treatment given to a patient.






27. Individually identifiable health information






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






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






30. 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






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






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






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






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






35. 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.






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






37. 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






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






39. A rule - condition - or requirement






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






41. 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






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






43. 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






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






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






46. American Medical Association






47. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






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






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