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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 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






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






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






4. 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.






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






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






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






8. 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






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






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






11. A monthly fee paid by the insured for specific medical insurance coverage






12. 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)






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






14. 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






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






16. 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






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






18. 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






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






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






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






22. 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






23. 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






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






25. 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






26. 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.






27. 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






28. 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






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






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






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






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






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






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






36. 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






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






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






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






40. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






42. 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






43. A nonprofit integrated delivery system






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






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






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






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






48. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






50. 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