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






2. 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






3. 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.






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






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

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






7. 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






8. Health Information Portability and Accountability Act






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






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






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






12. 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






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






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






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






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






17. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






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






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






20. 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






21. 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






22. A nonprofit integrated delivery system






23. American Medical Association






24. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






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






27. 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






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






29. 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.






30. Billing for services not performed






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






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






33. A nonprofit integrated delivery system






34. 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






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






36. 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






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






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






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






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






41. 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






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






43. 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






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






45. 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






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






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

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






49. 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






50. A provision that apples when a person is covered under more than one group medical program