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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. 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






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






3. Billing for services not performed






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






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

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






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






8. 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






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






10. Health Information Portability and Accountability Act






11. 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






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






13. Billing for services not performed






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






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






16. 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






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






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






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






20. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






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






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






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






25. The amount of actual money available to the medical practice






26. 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






27. 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






28. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






30. 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






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






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






33. 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.






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






35. 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






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






37. 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






38. American Medical Association






39. 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.






40. 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






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






42. 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






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






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






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






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






47. 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.






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






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






50. 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