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






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






3. 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






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






5. 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






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






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






8. 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






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






10. 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.






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






12. 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






13. 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






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






15. 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






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






17. 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.






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






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






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






21. A rule - condition - or requirement






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






23. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






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






26. 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






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






28. 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






29. 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






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






31. 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






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






33. 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






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






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






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






37. 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






38. A rule - condition - or requirement






39. 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






40. 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






41. American Medical Association






42. 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






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






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






45. 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






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






47. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






49. American Medical Association






50. 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