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






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






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






4. 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






5. Medical services provided on an outpatient basis






6. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






7. 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






8. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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. Is the provider who renders a service to a patient






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






13. A rule - condition - or requirement






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






15. 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






16. 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






17. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






19. 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






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






21. 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.






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






23. 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






24. 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






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






26. 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






27. Individually identifiable health information






28. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






29. 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






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






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






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






33. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






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






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






36. 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






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






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. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






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






41. American Medical Association






42. 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






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






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






45. 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.






46. 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.






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






48. 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






49. 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






50. 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.