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






2. 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






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






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






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






6. American Medical Association






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






8. 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.






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






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






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






12. 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






13. 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.






14. 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






15. 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






16. 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.






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






18. 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






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






20. 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






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






22. 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






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






24. 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.






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






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






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






29. 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.






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






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






32. A nonprofit integrated delivery system






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






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






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






36. 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.






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






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






39. 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






40. Medical services provided on an outpatient basis






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






42. 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






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






44. Customs - rules of conduct - courtesy - and manners of the medical profession






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






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






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






48. 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






49. A rule - condition - or requirement






50. 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