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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. 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.






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






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






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






5. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






7. 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






8. A rule - condition - or requirement






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






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






11. 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






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






13. 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.






14. American Medical Association






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






16. 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






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






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






19. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






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






22. A nonprofit integrated delivery system






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






24. 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






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






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






27. 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






28. The maximum amount a plan pays for a covered service






29. 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






30. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






31. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






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






34. 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






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






36. 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






37. 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






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






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






40. 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






41. American Medical Association






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






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






44. 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.






45. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






47. 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






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






49. 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






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