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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 nonprofit integrated delivery system






2. 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






3. 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






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






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






6. Medical services provided on an outpatient basis






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






8. Individually identifiable health information






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






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






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






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






13. American Medical Association






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






15. 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.






16. Health Information Portability and Accountability Act






17. 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






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






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






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

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21. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






22. 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.






23. 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






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






25. 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






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






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






28. 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






29. 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.






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






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






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






33. 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






34. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






35. 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






36. 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






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






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






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






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 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






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






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






44. Is the provider who renders a service to a patient






45. 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






46. A patient claim is eligible for medicare and medicaid






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






48. 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.






49. 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






50. 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.