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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 rule - condition - or requirement






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






3. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






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






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






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






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






8. American Medical Association






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






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






11. 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






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






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






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






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






16. 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






17. Medical services provided on an outpatient basis






18. Individually identifiable health information






19. Medical services provided on an outpatient basis






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






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






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






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






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






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


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






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






28. Unauthorized release of information






29. A rule - condition - or requirement






30. 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.






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






32. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






33. 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






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






35. 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






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






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






38. Billing for services not performed






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






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






41. 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






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






43. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






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






46. 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






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






48. 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






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






50. 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.