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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 - 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






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






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






4. 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.






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






6. 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






7. 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.






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






9. 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.






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






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






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






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






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






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






16. 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






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






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






19. 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






20. A rule - condition - or requirement






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






22. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






24. 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






25. 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






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






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






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






29. Someone who is eligible for or receiving benefits under an insurance policy or plan






30. 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






31. Unauthorized release of information






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






33. Individually identifiable health information






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






35. 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






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






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






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






39. 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






40. 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






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






42. 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.






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






44. 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






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






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






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






48. A rule - condition - or requirement






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






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