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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 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






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






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






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






5. 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






6. 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)






7. Health Information Portability and Accountability Act






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






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






10. Unauthorized release of information






11. 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






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






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. 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






15. 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






16. The period of time that payment for Medicare inpatient hospital benefits are available






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






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






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






20. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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






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






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






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






25. 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






26. 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






27. 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.






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






29. 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






30. 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.






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






32. 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






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






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






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






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






37. 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






38. 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.






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






40. 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






41. 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






42. 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.






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






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






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






46. 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






47. 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






48. 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






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






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