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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. 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






2. 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






3. 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)






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






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






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






7. 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.






8. Individually identifiable health information






9. 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.






10. 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






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






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






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






14. 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






15. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






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. 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






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






20. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






21. 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






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






23. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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






25. Individually identifiable health information






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






27. Medical staff member who is legally responsible for the care and treatment given to a patient.






28. 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.






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






30. 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






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






32. 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






33. 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






34. 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






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






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






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






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






39. 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






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






41. 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






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






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






44. A nonprofit integrated delivery system






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






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






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






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






49. 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






50. 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