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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. Medical services provided on an outpatient basis






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






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






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






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






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






7. Health Information Portability and Accountability Act






8. A rule - condition - or requirement






9. 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






10. 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






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






12. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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






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






15. A rule - condition - or requirement






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






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






18. Unauthorized release of information






19. 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






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






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






22. 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






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






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






25. 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






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






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






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






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






30. American Medical Association






31. 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






32. 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






33. An intentional misrepresentation of the facts to deceive or mislead another.






34. 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.






35. 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






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






37. 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.






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






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






40. 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.






41. 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.






42. 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






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






44. 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






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






46. Someone who is eligible for or receiving benefits under an insurance policy or plan






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






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






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






50. 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