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






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






3. 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






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






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






7. 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)






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






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






10. 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.






11. American Medical Association






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






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






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






15. 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.






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






17. American Medical Association






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






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






20. A patient claim is eligible for medicare and medicaid






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






22. 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






23. 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






24. 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






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






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






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






28. 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.






29. The amount of actual money available to the medical practice






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






31. A willful act by an employee of taking possession of an employer's money






32. 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






33. 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






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






35. 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






36. 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






37. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






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






41. Is a provider who sends the patients for testing or treatment






42. 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






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






44. 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.






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






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






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






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






49. 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






50. 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