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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 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)






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






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






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






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






6. 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






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






8. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






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






11. 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






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






13. 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)






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






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






16. 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.






17. 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






18. 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






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






20. 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






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






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






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






25. 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






26. 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.






27. A patient claim is eligible for medicare and medicaid






28. 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






29. 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






30. 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.






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






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






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






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

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35. 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






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






37. 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






38. Billing for services not performed






39. 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.






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






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






42. 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.






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






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






45. 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






46. 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






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






48. A nonprofit integrated delivery system






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






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