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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 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






2. A rule - condition - or requirement






3. 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






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






5. 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






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






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






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






9. 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.






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






11. 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






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






13. 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






14. 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






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






16. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






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






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






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






20. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






21. Individually identifiable health information






22. 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






23. 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






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






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






26. 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.






27. 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






28. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






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






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






31. 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






32. 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






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






34. 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






35. 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






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






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






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






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






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






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






42. 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






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






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






45. 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






46. Unauthorized release of information






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






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






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






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