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






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






3. 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.






4. 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






5. 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






6. 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.






7. 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






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






9. 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.






10. 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






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






12. 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.






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






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






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






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






17. 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






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






19. 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






20. 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






21. Billing for services not performed






22. 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






23. 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






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






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






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






27. 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.






28. Health Information Portability and Accountability Act






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






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






31. 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






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






33. 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






34. 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






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






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






37. A nonprofit integrated delivery system






38. 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






39. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






40. A rule - condition - or requirement






41. 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






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






43. 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.






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






45. 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






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






47. 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.






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






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






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