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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. Billing for services not performed






2. 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






3. 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






4. 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.






5. 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.






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






7. Unauthorized release of information






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






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






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






11. A patient claim is eligible for medicare and medicaid






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






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






14. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






15. 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.






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






17. 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






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






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






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






21. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






22. 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






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






24. 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






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






26. 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






27. 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






28. 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






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






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






31. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






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






34. 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






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






36. Health Information Portability and Accountability Act






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






38. 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.






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






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






41. 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.






42. 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






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






45. 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






46. 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.






47. Individually identifiable health information






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






49. A nonprofit integrated delivery system






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







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