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






2. 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






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






4. 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






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






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






7. A rule - condition - or requirement






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






9. 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






10. 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.






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. 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






13. 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






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






15. 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






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






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






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






19. 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






20. 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






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






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






23. 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)






24. 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






25. American Medical Association






26. 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






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






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






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






30. The dates of healthcare services were provided to the beneficiary






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






32. 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






33. 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






34. 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






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






36. 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






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






38. 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






39. 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






40. 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






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






42. 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






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






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






45. Individually identifiable health information






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






47. 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.






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






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






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