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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 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






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






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






4. 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






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






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






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






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






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






10. 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






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






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






13. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






14. 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.






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






16. 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






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






19. 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)






20. American Medical Association






21. 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






22. 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.






23. American Medical Association






24. 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






25. 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.






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






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






28. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






30. 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






31. 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.






32. 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






33. 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






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






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






36. 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.






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






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






39. 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.






40. 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.






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






42. 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






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






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






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






46. 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






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






48. 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






49. 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.






50. 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