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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. 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






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






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






5. 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






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






7. Individually identifiable health information






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






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






10. 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






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






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






13. 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






14. 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.






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






16. 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






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






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






19. 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






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






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






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






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






24. 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






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






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






27. American Medical Association






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. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






30. Health Information Portability and Accountability Act






31. 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






32. 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






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






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






35. Unauthorized release of information






36. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






38. 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






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






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






41. 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






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






44. 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.






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






46. 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






47. 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






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






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






50. 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