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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. 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.






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






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






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






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






6. 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






7. 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






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






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






10. 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






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






12. 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






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






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






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






16. 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.






17. 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






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






19. 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.






20. American Medical Association






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






22. 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






23. 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






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






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






26. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






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






28. 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






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






30. 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






31. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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






33. Medicare's method of paying acute care hospitals for inpatient care






34. 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






35. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






36. 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)






37. 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.






38. 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






39. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






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






42. 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.






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






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


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






46. 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






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






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






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






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