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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 structure for classifying outpatient services and procedures for purpose of payment






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






3. 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






4. Unauthorized release of information






5. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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






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






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






9. Unauthorized release of information






10. 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.






11. 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






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






13. A patient claim is eligible for medicare and medicaid






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






15. 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






16. 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






17. 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






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






19. 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






20. 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.






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






22. 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






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






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






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






26. 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.






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






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






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






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






31. 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






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






33. Billing for services not performed






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






35. 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.






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






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. 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






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






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






41. A patient claim is eligible for medicare and medicaid






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






43. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






45. 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






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






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






48. 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






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






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