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






2. 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






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






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






5. 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.






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






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






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






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






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






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






12. 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






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






14. 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






15. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






16. Medical services provided on an outpatient basis






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






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






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






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






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






22. 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






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






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






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






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






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






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






29. 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






30. 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






31. 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.






32. 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






33. 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






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






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






36. 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.






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






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






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






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






41. A rule - condition - or requirement






42. 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)






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






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






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






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






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






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






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






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