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






2. 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






3. 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






4. 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






5. 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






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






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






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






9. 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






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






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






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






13. A nonprofit integrated delivery system






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 care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






17. 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






18. 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






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






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






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






22. American Medical Association






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






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






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






26. 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






27. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






29. 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






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






31. 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






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






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






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






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






36. A patient claim is eligible for medicare and medicaid






37. 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.






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






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






40. 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






41. The condition of being secluded from the presence or view of others.






42. 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






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






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






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






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






47. 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






48. 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






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






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