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






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






3. 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






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






5. 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.






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






8. Unauthorized release of information






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






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






11. 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.






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






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






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






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






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






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






18. 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






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






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






21. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






22. 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






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






24. 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.






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






26. 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.






27. 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






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






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






30. 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






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






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






33. 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






34. American Medical Association






35. Individually identifiable health information






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






37. A nonprofit integrated delivery system






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






39. Individually identifiable health information






40. 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






41. 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






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






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






44. 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






45. 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






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






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






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. 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