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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 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.






2. 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.






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






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






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






6. 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.






7. 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






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






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






10. 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






11. 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.






12. Unauthorized release of information






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






14. 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






15. 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






16. 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






17. Billing for services not performed






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






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






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






21. Medicare's method of paying acute care hospitals for inpatient care






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






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






24. 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






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






26. 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






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






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






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






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. Verbal or written agreement that gives approval to some action - situation - or statement.






32. 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






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






34. 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






35. A nonprofit integrated delivery system






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






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






38. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






39. 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.






40. 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






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






42. Medical services provided on an outpatient basis






43. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






44. 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






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






46. 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






47. 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






48. 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.






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






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