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






2. Medical services provided on an outpatient basis






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






4. 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






5. 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






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






7. 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






8. 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






9. 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.






10. 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






11. 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






12. 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






13. 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






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






15. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






17. 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






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






19. Billing for services not performed






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






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






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






23. 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.






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






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






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






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






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






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






30. 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.






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






32. 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






33. 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






34. Medical services provided on an outpatient basis






35. 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






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






37. Integrating benefits payable under more than one health insurance.






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






39. 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)






40. A rule - condition - or requirement






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






42. American Medical Association






43. 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






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






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






46. 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






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






48. Billing for services not performed






49. Health Information Portability and Accountability Act






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