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






2. 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






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






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






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






6. 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






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






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






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






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






11. A nonprofit integrated delivery system






12. 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






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






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






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






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






17. 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






18. 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






19. A rule - condition - or requirement






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






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






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






23. American Medical Association






24. 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






25. A rule - condition - or requirement






26. 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






27. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






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






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






31. 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






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






33. 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






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






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






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






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






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






39. Unauthorized release of information






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






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






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






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






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. 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






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






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






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






50. 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