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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. 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






2. 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






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






4. A nonprofit integrated delivery system






5. 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.






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






7. Is a provider who sends the patients for testing or treatment






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






9. 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






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






11. 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






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






13. 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






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






15. Individually identifiable health information






16. 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






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






18. 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






19. 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






20. 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






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






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. 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






24. Billing for services not performed






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






26. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






28. 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






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






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






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






32. 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






33. 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






34. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






35. 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






36. 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.






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






38. Medicare's method of paying acute care hospitals for inpatient care






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






40. 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.






41. 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






42. 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






43. 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






44. 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






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






46. 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






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






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






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






50. A patient claim is eligible for medicare and medicaid