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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. 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.






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






3. 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.






4. A nonprofit integrated delivery system






5. Health Information Portability and Accountability Act






6. 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.






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






8. 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






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






10. 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






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






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






13. 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






14. Health Information Portability and Accountability Act






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






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. 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






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






19. 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






20. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






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






22. 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)






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






24. 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






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

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






27. 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






28. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






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






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






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






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






33. Billing for services not performed






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






35. 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






36. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






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






40. 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






41. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






42. 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






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






44. 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)






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






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






48. 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






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






50. 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.