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






2. 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.






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






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






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






7. 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






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






9. 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






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






11. 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






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






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






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






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






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






17. 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






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






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






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






21. 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






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






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






24. 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






25. 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.






26. Unauthorized release of information






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






28. 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






29. 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.






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






31. 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






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






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






34. 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.






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






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






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






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






39. 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.






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






41. 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






42. 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.






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






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






45. American Medical Association






46. Billing for services not performed






47. 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






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






49. 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






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