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






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






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






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






5. 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






6. 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.






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






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






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






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






11. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






12. 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.






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






14. 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






15. 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






16. 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






17. 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






18. 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






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






20. A nonprofit integrated delivery system






21. 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






22. 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






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






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






25. A rule - condition - or requirement






26. A patient claim is eligible for medicare and medicaid






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






28. 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






29. A structure for classifying outpatient services and procedures for purpose of payment






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






31. 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.






32. 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






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






34. 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.






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






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






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






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. 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






40. Health Information Portability and Accountability Act






41. Billing for services not performed






42. 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






43. 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.






44. 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.






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






46. 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






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

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






49. American Medical Association






50. 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)