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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 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






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






3. 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.






4. 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






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






6. 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






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






8. 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.






9. 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.






10. 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






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






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






13. 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.






14. 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






15. A rule - condition - or requirement






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






17. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






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






21. 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.






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






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






24. 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






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






26. 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






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






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






29. 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






30. 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.






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






32. 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.






33. 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






34. 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






35. 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






36. 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.






37. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






40. Billing for services not performed






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






42. A patient claim is eligible for medicare and medicaid






43. 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






44. 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






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






46. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






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






49. 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.






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