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






2. 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






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






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






5. 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






6. 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)






7. Billing for services not performed






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






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






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






11. Unauthorized release of information






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






13. 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






14. 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






15. 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






16. 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






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






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






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






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






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






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






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






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






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






26. 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






27. American Medical Association






28. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






29. Is the provider who renders a service to a patient






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






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






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

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






34. A patient claim is eligible for medicare and medicaid






35. 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






36. 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






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






38. 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






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






40. 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






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






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






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






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






45. 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






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






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






48. 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






49. 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






50. 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