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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. Integrating benefits payable under more than one health insurance.






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






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






4. Customs - rules of conduct - courtesy - and manners of the medical profession






5. 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






6. 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






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






8. Medicare's method of paying acute care hospitals for inpatient care






9. American Medical Association






10. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






11. 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






12. 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.






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






14. 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.






15. Customs - rules of conduct - courtesy - and manners of the medical profession






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






17. 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






18. 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






19. 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.






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






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






22. 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.






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






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






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






26. 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






27. Individually identifiable health information






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






29. 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.






30. 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






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






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






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






34. 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






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






36. A nonprofit integrated delivery system






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






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






39. 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






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






42. 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






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






44. 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






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






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






47. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






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






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






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