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






2. 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






3. 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






4. 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






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






6. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






7. 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






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






9. 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






10. 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.






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






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






13. What the insurance company will consider paying for as defined in the contract.






14. Unauthorized release of information






15. 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






16. 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






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






18. 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.






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






20. 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






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






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






23. 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.






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






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






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






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






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






29. 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






30. 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






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






32. 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






33. 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.






34. 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






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






36. American Medical Association






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






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






39. 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)






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






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






42. Medical services provided on an outpatient basis






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






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






45. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






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. A rule - condition - or requirement






49. 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






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