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






2. Medical services provided on an outpatient basis






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






4. 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






5. Billing for services not performed






6. 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






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






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






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






10. 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






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






12. 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.






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. 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.






15. 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






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






17. A rule - condition - or requirement






18. 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






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






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






21. 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






22. 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






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






24. 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






25. 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)






26. A monthly fee paid by the insured for specific medical insurance coverage






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






28. 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.






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






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






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






32. 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






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






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






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






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






37. 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






38. 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






39. 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






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






41. 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.






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






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






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






45. A rule - condition - or requirement






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






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






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






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






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