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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. 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.






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






3. Individually identifiable health information






4. 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






5. Billing for services not performed






6. A nonprofit integrated delivery system






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






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






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






10. 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






11. Medical services provided on an outpatient basis






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






13. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






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






16. The dates of healthcare services were provided to the beneficiary






17. 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






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






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






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






21. 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






22. Medical services provided on an outpatient basis






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






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






25. 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.






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






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






28. 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






29. 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






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






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






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






33. 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.






34. 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.






35. 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






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






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






38. 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






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






40. 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






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






42. Health Information Portability and Accountability Act






43. 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






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






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






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






47. 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.






48. American Medical Association






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






50. 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