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






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






3. A nonprofit integrated delivery system






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






5. 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.






6. 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






7. 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






8. 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






9. 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






10. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






11. 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






12. Billing for services not performed






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






14. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






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






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






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






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






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






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






21. 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






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






23. 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






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






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






26. 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






27. 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






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






29. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






30. 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






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






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






33. 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






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






35. 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.






36. American Medical Association






37. 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






38. 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






39. 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






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






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






42. 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






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






44. 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






45. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






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






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






48. 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)






49. 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






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