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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 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






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






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






4. 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.






5. American Medical Association






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






7. 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






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






9. 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






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

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






12. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






14. 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






15. 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.






16. 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.






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






18. 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






19. Billing for services not performed






20. 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






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






22. 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.






23. 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






24. 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






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






26. 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






27. The maximum amount a plan pays for a covered service






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






29. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






31. 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.






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






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






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






35. 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)






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






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






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






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






40. 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






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






42. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






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






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






45. 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






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






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






48. 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






49. American Medical Association






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