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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. 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.






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






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






4. 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






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






6. Health Information Portability and Accountability Act






7. 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






8. 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






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






10. 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






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






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






13. 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.






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






15. 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






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






17. 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






18. 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.






19. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






20. 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.






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






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






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






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






25. 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






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






27. 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)






28. 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






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






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






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






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






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






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






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






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






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






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






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






40. 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






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






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






43. 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






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






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






47. Medical services provided on an outpatient basis






48. 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






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






50. 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







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