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






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






3. 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.






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






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






6. 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)






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






8. 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.






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






10. 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.






11. 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






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






13. A rule - condition - or requirement






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






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






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






17. 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.






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






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






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






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. 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






23. 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






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






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






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






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






28. 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






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






30. 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






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






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






33. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






34. 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.






35. A patient claim is eligible for medicare and medicaid






36. 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






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






40. 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.






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






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






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






44. A patient claim is eligible for medicare and medicaid






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






46. 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






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






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






49. Unauthorized release of information






50. 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