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






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






3. 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






4. 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






5. 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






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






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






8. 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






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






10. 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






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






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






13. Unauthorized release of information






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






15. 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.






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






17. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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18. 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






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






20. 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






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






22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






24. 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






25. 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






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






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






28. 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.






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






30. 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






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






32. 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






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






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






35. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






36. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






37. 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.






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






39. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






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






41. 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






42. 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






43. 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






44. 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






45. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






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. 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)






49. A rule - condition - or requirement






50. 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.