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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. 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)






2. 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






3. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






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






6. 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






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






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






9. 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






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






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






12. 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






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






14. 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






15. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






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






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






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






21. Unauthorized release of information






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






23. Billing for services not performed






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






25. 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






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






27. 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






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






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






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






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






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






33. 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.






34. 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






35. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






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






38. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






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






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






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






44. Unauthorized release of information






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






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






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






48. 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






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






50. 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