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






2. 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






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






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






6. 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






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






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






9. 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.






10. 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






11. 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






12. 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.






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






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






15. 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






16. American Medical Association






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






18. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






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






20. 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.






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






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






23. 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






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






25. 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






26. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






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






28. A nonprofit integrated delivery system






29. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






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






31. 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






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






33. Health Information Portability and Accountability Act






34. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






36. 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






37. Unauthorized release of information






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






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






40. A nonprofit integrated delivery system






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






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






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






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






45. Unauthorized release of information






46. 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






47. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






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. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






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