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






2. 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






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






4. 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.






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






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






7. 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






8. 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






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






10. 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.






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






12. 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






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






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






15. 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






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






18. 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.






19. 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






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






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






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






23. 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






24. 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






25. 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






26. 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






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






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






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






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






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






32. Individually identifiable health information






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






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






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






36. 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.






37. 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.






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






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






40. 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






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






42. 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)






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






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






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






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

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47. 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






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






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






50. Health Information Portability and Accountability Act