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






2. 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






3. 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






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

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






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






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






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






9. Unauthorized release of information






10. A patient claim is eligible for medicare and medicaid






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






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






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






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. 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






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






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






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






20. 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.






21. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






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






23. 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






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






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






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






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






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






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






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






31. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






32. A patient claim is eligible for medicare and medicaid






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






34. Health Information Portability and Accountability Act






35. Medical services provided on an outpatient basis






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






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






38. 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






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






40. 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






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






42. 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






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






44. 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






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






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






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






48. Unauthorized release of information






49. Someone who is eligible for or receiving benefits under an insurance policy or plan






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