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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 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)






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






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






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






5. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






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






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






9. 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.






10. 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






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






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






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






14. 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






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






16. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






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






18. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






19. Health Information Portability and Accountability Act






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






21. 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






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






23. 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






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






25. 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






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






27. 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






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






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






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






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






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






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






34. 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






35. 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.






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






37. Individually identifiable health information






38. 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






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. 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






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






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






43. Unauthorized release of information






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






45. 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.






46. 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






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






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






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






50. 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