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






2. 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.






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






4. 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






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






6. 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.






7. 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






8. 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)






9. 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






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






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






12. 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






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






14. American Medical Association






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






16. 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






17. 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






18. A nonprofit integrated delivery system






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






20. Health Information Portability and Accountability Act






21. 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






22. 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






23. 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






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






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






26. 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






27. 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






28. 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






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






30. Health Information Portability and Accountability Act






31. 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.






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


33. 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






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






35. 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






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






37. 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






38. 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






39. 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






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






41. 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






42. 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






43. 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.






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






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






46. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






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






49. 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.






50. 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