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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 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






2. 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






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






4. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






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. 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






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






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






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






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






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






12. 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






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






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






15. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






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






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. Unauthorized release of information






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






20. 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






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






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






23. 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






24. 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






25. 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






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






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






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






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






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






31. 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






32. 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.






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






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






35. 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






36. 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






37. 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






38. 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






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






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






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






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






43. 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






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






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






46. 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






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






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






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






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