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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. 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






2. 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






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






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






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






6. 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






7. 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






8. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






10. Individually identifiable health information






11. 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.






12. Individually identifiable health information






13. 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.






14. 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






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






16. 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






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






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






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






20. 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






21. 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






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






23. 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






24. 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






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






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






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






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






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






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






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






32. 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






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






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






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






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






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






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






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






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






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






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






43. 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






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






45. American Medical Association






46. 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






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






48. Medical services provided on an outpatient basis






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






50. A rule - condition - or requirement