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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. 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






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






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






5. A review of the need for inpatient hospital care - completed before the actual admission






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






7. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






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






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






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






11. 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






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






13. 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






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






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






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






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






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






19. 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






20. 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.






21. 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






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






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






24. Medical services provided on an outpatient basis






25. 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.






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






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






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






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






30. 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






31. 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.






32. Health Information Portability and Accountability Act






33. Health Information Portability and Accountability Act






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






35. 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






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






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






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






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






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






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






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






43. 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






44. 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.






45. 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






46. Unauthorized release of information






47. 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






48. 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






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






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