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






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






3. Medical services provided on an outpatient basis






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






5. 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






6. 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






7. Billing for services not performed






8. 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






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






10. 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






11. 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






12. American Medical Association






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






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






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






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






17. 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






18. A rule - condition - or requirement






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






20. 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






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






22. 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






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






24. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






25. 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.






26. 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






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






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






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






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






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






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






33. 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






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






35. 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






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






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






38. 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)






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






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






41. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






43. 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






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






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

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46. 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






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






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






49. 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)






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