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






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






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






4. 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






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






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






7. A nonprofit integrated delivery system






8. 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.






9. 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






10. 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






11. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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






13. 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






14. Unauthorized release of information






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






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






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






18. 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






19. Health Information Portability and Accountability Act






20. 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






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






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






23. 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






24. 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






25. 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






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






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






28. 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






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






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. 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






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






33. American Medical Association






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






35. 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






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






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






38. A review of the need for inpatient hospital care - completed before the actual admission






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






40. 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.






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






42. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






43. 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.






44. Billing for services not performed






45. 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






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






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






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






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