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






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






3. 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






4. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






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






6. 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






7. 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






8. 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






9. 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






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






11. 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






12. Standards of conduct generally accepted as a moral guide for behavior.






13. 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






14. 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.






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






16. 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






17. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






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






20. 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






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






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






23. Health Information Portability and Accountability Act






24. 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






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






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






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






28. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






30. American Medical Association






31. Medical services provided on an outpatient basis






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






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






34. 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






35. 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






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






37. 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.






38. 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.






39. 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






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. 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






42. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






43. Approval or consent by a primary physician for patient referral to ancillary services and specialists






44. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






45. 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






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






47. Billing for services not performed






48. A patient claim is eligible for medicare and medicaid






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






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