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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. 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






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






3. 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.






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






5. 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






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






7. 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






8. 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






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






10. 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)






11. 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






12. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






14. Unauthorized release of information






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






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






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






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






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






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






21. 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.






22. American Medical Association






23. 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






24. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






25. A provision that apples when a person is covered under more than one group medical program






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






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






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






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






30. 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






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. 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






33. A nonprofit integrated delivery system






34. Billing for services not performed






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






36. 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.






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






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






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






40. 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.






41. The transmission of information between two parties to carry out financial or administrative activities related to health care.






42. 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






43. 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






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






45. Individually identifiable health information






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






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






48. 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






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






50. 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