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

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






3. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






4. 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






5. 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)






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






7. 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






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






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






10. 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






11. 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.






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






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






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






16. 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






17. 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.






18. 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






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






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






21. What the insurance company will consider paying for as defined in the contract.






22. 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.






23. A list of the amount to be paid by an insurance company for each procedure service






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






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






26. 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






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






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






29. Billing for services not performed






30. 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






31. 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






32. Unauthorized release of information






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






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






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






36. 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






37. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






39. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






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






42. A patient claim is eligible for medicare and medicaid






43. American Medical Association






44. Billing for services not performed






45. 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






46. 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






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






48. 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






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






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







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