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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. Health Information Portability and Accountability Act






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






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






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






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






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






7. 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.






8. 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






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






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






11. Medical services provided on an outpatient basis






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






13. A rule - condition - or requirement






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






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






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






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






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






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






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






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






22. 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






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






24. 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.






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






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






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






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






29. 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






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






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






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






33. A health insurance enrollee chooses to see an out of network provider without authorization






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






35. 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






36. A health insurance enrollee chooses to see an out of network provider without authorization






37. Unauthorized release of information






38. 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)






39. 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.






40. 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






41. 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.






42. 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






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






44. 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






45. 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






46. 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.






47. Medical services provided on an outpatient basis






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






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






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