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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 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






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






3. 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






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






5. 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






6. 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






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






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






9. Individually identifiable health information






10. 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






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






12. Individually identifiable health information






13. 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.






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






15. 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.






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






17. A rule - condition - or requirement






18. 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






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






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






21. 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)






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






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






24. A nonprofit integrated delivery system






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






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






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






28. 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






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






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






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






32. 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






33. 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






34. 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






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






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






37. Unauthorized release of information






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






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






40. Billing for services not performed






41. 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






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






43. 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






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






45. 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






46. 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






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






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






49. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






50. American Medical Association