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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. Is a provider who sends the patients for testing or treatment






2. 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






3. 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.






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






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






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






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






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






9. 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






10. 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






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






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






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






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






15. 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.






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






17. 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)






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 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






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






21. 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.






22. 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






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






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






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






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






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






28. Billing for services not performed






29. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






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

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






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. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






35. 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






36. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






37. A nonprofit integrated delivery system






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






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






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






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






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






43. 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






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






45. 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






46. 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






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






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






49. Unauthorized release of information






50. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated