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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. 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






2. 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)






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. 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






5. 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






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






7. 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






8. 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






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






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






11. 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






12. 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.






13. 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






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






15. 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






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






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






18. Is a provider who sends the patients for testing or treatment






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






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






21. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






22. A nonprofit integrated delivery system






23. The condition of being secluded from the presence or view of others.






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






25. 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






26. 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.






27. 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






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






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






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






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






32. 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.






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






34. Medical services provided on an outpatient basis






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






36. 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






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






38. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






39. 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






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






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






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






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






44. 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






45. 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






46. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






47. 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






48. 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






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






50. 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