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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. 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.






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






3. 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






4. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






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






6. 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.






7. 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






8. 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






9. 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






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






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






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






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






15. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






16. A nonprofit integrated delivery system






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






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






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






20. 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.






21. 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






22. 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






23. Unauthorized release of information






24. 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.






25. 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






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






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






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






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






30. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






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






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






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






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






35. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






36. 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






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






38. 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






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






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






41. 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






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






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






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






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






46. 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.






47. 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






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






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






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







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