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






2. 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






3. Unauthorized release of information






4. 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.






5. 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.






6. 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






7. 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






8. 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.






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






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






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






12. 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.






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






14. The maximum amount a plan pays for a covered service






15. Medical services provided on an outpatient basis






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

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






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






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






20. 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






21. 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






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






23. Integrating benefits payable under more than one health insurance.






24. 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)






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






26. 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)






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






29. 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






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






31. 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






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






33. 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






34. 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






35. 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






36. 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






37. 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






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






39. 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






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






41. 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






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






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






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






45. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






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






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






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






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