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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 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.






2. 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






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






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






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






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






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






8. The amount of actual money available to the medical practice






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






10. Unauthorized release of information






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






12. 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






13. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






14. Is a provider who sends the patients for testing or treatment






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






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






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






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






19. 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






20. 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






21. 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






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






23. A nonprofit integrated delivery system






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






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






26. 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






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






28. 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






29. Individually identifiable health information






30. A health insurance enrollee chooses to see an out of network provider without authorization






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






32. 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






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






34. 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






35. 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






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






37. Someone who is eligible for or receiving benefits under an insurance policy or plan






38. 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






39. 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






40. Is a provider who sends the patients for testing or treatment






41. Billing for services not performed






42. 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






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

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44. 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






45. 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






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

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47. Unauthorized release of information






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






49. 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






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