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






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






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






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






5. 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






6. 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






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






8. 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






9. Unauthorized release of information






10. 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






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






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






13. 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






14. 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.






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






16. 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.






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






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






19. 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






20. 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






21. 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.






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






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






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






25. 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






26. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






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. 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






29. 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






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






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






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






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

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

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






36. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






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






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






40. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






41. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






42. 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






43. A patient claim is eligible for medicare and medicaid






44. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






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






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






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






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






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






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