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






2. 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






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






4. 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






5. 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






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






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






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






9. Billing for services not performed






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






11. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






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






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






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






15. Verbal or written agreement that gives approval to some action - situation - or statement.






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






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






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






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. 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






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






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. 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






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






25. 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






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






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






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






29. 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






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






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






32. 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






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






35. 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






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






37. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






38. 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






39. 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






40. Verbal or written agreement that gives approval to some action - situation - or statement.






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






42. 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






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






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






45. 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






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

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47. Health Information Portability and Accountability Act






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






49. 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






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