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






2. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






3. 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






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






5. 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






6. Billing for services not performed






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






8. Is the provider who renders a service to a patient






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






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






11. 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






12. 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






13. 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






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






15. 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






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






17. 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.






18. Health Information Portability and Accountability Act






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






20. 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.






21. 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






22. 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






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






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






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






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






27. 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






28. 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






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






30. 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






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






32. A patient claim is eligible for medicare and medicaid






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






34. 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






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






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






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. 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






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






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






41. 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)






42. 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.






43. 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






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






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






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






47. 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






48. Individually identifiable health information






49. American Medical Association






50. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services