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






2. Individually identifiable health information






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






4. 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






5. 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






6. 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






7. Medical services provided on an outpatient basis






8. 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






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






10. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






11. 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






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






13. The transmission of information between two parties to carry out financial or administrative activities related to health care.






14. 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.






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






16. 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






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






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






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






20. A rule - condition - or requirement






21. 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






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






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






24. 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






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






26. 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.






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






28. 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






29. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






30. 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






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






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






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






34. 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






35. 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.






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






37. 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






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






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






40. 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






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






42. Health Information Portability and Accountability Act






43. 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






44. 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






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






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






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






48. Billing for services not performed






49. A structure for classifying outpatient services and procedures for purpose of payment






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