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






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






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






4. 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






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






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






7. 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






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






9. 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.






10. A nonprofit integrated delivery system






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






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






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






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






15. 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






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






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






18. 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.






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






20. 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






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






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






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






24. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






25. 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.






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






27. 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






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






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






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






31. 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






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






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






34. 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






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






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






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






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






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






40. 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






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






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






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






44. A rule - condition - or requirement






45. 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






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






47. The period of time that payment for Medicare inpatient hospital benefits are available






48. 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.






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






50. Health Information Portability and Accountability Act