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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. 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






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






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






4. 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






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






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






7. 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






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






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






10. 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






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






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






13. 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






14. 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.






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






16. 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.






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






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






19. 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






20. 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






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






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






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






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






25. 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






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






27. Integrating benefits payable under more than one health insurance.






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






29. 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






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






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






32. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






33. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






36. 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






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






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






39. 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






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. Unauthorized release of information






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






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






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






45. 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






46. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






48. 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






49. 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.






50. The condition of being secluded from the presence or view of others.