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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. 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






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






3. 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






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






5. 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






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






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






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






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






10. Individually identifiable health information






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






12. 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






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






14. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






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






17. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






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






21. A nonprofit integrated delivery system






22. 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






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






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






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






26. Medical services provided on an outpatient basis






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






28. 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






29. The condition of being secluded from the presence or view of others.






30. 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






31. Billing for services not performed






32. 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.






33. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






34. Individually identifiable health information






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






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






37. 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






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






39. 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






40. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






42. 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






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






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






45. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






47. 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






48. The dates of healthcare services were provided to the beneficiary






49. The dates of healthcare services were provided to the beneficiary






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