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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 form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






3. 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






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






5. Billing for services not performed






6. 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.






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






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






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






10. 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






11. 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.






12. 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






13. 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






14. 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






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






16. 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.






17. 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






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






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






20. 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






21. American Medical Association






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






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






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






25. 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.






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






27. A nonprofit integrated delivery system






28. 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






29. A rule - condition - or requirement






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






31. 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






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






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






34. 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






35. 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






36. Medical staff member who is legally responsible for the care and treatment given to a patient.






37. 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.






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






39. Health Information Portability and Accountability Act






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






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






42. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






43. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






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. 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






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






48. 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






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






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

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