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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 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






2. 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






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






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






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






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






7. 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






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






9. Medical services provided on an outpatient basis






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






11. 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






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






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






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






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






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






18. 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






19. 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






20. 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






21. 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.






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






24. Individually identifiable health information






25. 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.






26. 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






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






28. A patient claim is eligible for medicare and medicaid






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






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






31. The transmission of information between two parties to carry out financial or administrative activities related to health care.






32. 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






33. American Medical Association






34. 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






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






36. 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






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






38. Billing for services not performed






39. 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.






40. 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






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






42. 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






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






44. 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






45. 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.






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






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






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






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






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