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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. 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






2. 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






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






4. 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






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






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






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






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






9. 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






10. 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






11. 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






12. 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






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






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






15. 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






16. 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






17. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






18. 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






19. Medical services provided on an outpatient basis






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






21. 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.






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






23. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.


24. 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






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






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






27. 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.






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






29. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






31. A nonprofit integrated delivery system






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






33. 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






34. 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






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






36. 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






37. 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.






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. 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.






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






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






42. Health Information Portability and Accountability Act






43. 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






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






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






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






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






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






49. 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






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