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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. The maximum amount a plan pays for a covered service






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






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






4. 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






5. 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.






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






7. 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.






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






9. Billing for services not performed






10. 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






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






12. 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.






13. 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






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






15. 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.






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






17. 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






18. 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.






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






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






21. 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






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






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






24. Individually identifiable health information






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






26. 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.






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






28. 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.






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






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






31. 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.






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






33. 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






34. 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






35. American Medical Association






36. 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






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






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






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






40. 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






41. 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.






42. Medical services provided on an outpatient basis






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






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






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






46. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






48. 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






49. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






50. 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







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