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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 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






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






3. 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






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






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






6. 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






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






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






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






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






11. 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






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






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






14. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






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






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






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






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






20. 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.






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






22. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






23. 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






24. 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






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






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






27. Health Information Portability and Accountability Act






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






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






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

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31. 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






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






33. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






34. 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






35. 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






36. 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.






37. A list of the amount to be paid by an insurance company for each procedure service






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






39. 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






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






41. A patient claim is eligible for medicare and medicaid






42. A rule - condition - or requirement






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






44. 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






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






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






47. 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






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






49. American Medical Association






50. 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