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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 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.






2. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






3. Health Information Portability and Accountability Act






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






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






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






7. 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)






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






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






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






11. 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






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






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






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






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






16. 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






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






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






19. 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






20. 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






21. Individually identifiable health information






22. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






23. 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






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






25. Billing for services not performed






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






27. 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






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






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






30. 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






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






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






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






35. 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






36. 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.






37. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






38. 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.






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






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






41. 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






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. 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






44. 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






45. A nonprofit integrated delivery system






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






47. 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.






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






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






50. American Medical Association