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






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






3. Health Information Portability and Accountability Act






4. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






5. 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






6. 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






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






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






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






10. 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






11. 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






12. 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






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






14. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






15. 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






16. 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






17. Individually identifiable health information






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






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






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






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






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






23. 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






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






25. 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)






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






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






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






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






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






31. 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






32. 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.






33. 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.






34. 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.






35. 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






36. 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






37. 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






38. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






39. Verbal or written agreement that gives approval to some action - situation - or statement.






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






41. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






42. 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






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






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






45. 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






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






47. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






49. A review of the need for inpatient hospital care - completed before the actual admission






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