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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 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.






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






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






4. 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.






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






6. 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






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






8. 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






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






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






11. 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






12. 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






13. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






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






15. 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






16. 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






17. 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.






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






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






20. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






21. 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






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






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






24. 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






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






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






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






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






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






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






32. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






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






34. A structure for classifying outpatient services and procedures for purpose of payment






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






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






37. 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.






38. 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






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






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






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






42. 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






43. 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)






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






45. 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






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






47. 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.






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






49. The dates of healthcare services were provided to the beneficiary






50. What the insurance company will consider paying for as defined in the contract.