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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. Is the provider who renders a service to a patient






2. 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.






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






4. 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






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






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






7. 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






8. 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






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






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






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






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






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






14. 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






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






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






17. 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






18. 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.






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






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






21. The period of time that payment for Medicare inpatient hospital benefits are available






22. Billing for services not performed






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






24. 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






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






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






27. 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.






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. A patient claim is eligible for medicare and medicaid






30. 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






31. 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






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






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






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






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






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






37. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






38. 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






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






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






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






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






43. 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






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






45. Health Information Portability and Accountability Act






46. 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






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






48. 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






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






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