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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. The amount of actual money available to the medical practice






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






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






4. 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






5. A willful act by an employee of taking possession of an employer's money






6. A patient claim is eligible for medicare and medicaid






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






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






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






10. American Medical Association






11. 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)






12. 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






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






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






15. Billing for services not performed






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






17. 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






18. Individually identifiable health information






19. 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






20. 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






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






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






23. 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






24. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






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






26. A willful act by an employee of taking possession of an employer's money






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






28. A nonprofit integrated delivery system






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






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






31. 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.






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






33. 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






34. 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






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






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






37. The amount of actual money available to the medical practice






38. 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






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






40. 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






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






42. 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)






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






44. 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.






45. Health Information Portability and Accountability Act






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

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47. 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.






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






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






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