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






2. 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.






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






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






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






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






7. 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






8. 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.






9. 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






10. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






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






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






14. Health Information Portability and Accountability Act






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






16. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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






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






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






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






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 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.






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






24. 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






25. Billing for services not performed






26. 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






27. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






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






29. 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






30. 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.






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






32. 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






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






34. 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






35. 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.






36. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






37. 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






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






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






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






41. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






42. 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






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






44. 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






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






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






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






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






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






50. 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