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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 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)






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






3. 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






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






5. 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






6. 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.






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






8. Health Information Portability and Accountability Act






9. 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






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






11. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






12. 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






13. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






15. 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.






16. 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






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






18. 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)






19. A rule - condition - or requirement






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






21. 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






22. 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.






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






24. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






25. 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






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






27. 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






28. 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






29. 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






30. A health insurance enrollee chooses to see an out of network provider without authorization






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






32. 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






33. The amount of actual money available to the medical practice






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. 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.






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






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






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






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






40. 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






41. 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.






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






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






44. 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.






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






46. A patient claim is eligible for medicare and medicaid






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






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






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






50. Health Information Portability and Accountability Act