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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 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






2. 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






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






4. 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






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






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






7. 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






8. 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.






9. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






11. 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






12. A review of the need for inpatient hospital care - completed before the actual admission






13. A nonprofit integrated delivery system






14. A review of the need for inpatient hospital care - completed before the actual admission






15. 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






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






17. 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






18. 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






19. A patient claim is eligible for medicare and medicaid






20. Health Information Portability and Accountability Act






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






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






23. 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






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






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

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26. 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.






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






28. 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






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






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 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)






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






33. Billing for services not performed






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






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






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






39. 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






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






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






42. 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.






43. A rule - condition - or requirement






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






45. 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.






46. Unauthorized release of information






47. 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






48. Medical services provided on an outpatient basis






49. Individually identifiable health information






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