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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. What the insurance company will consider paying for as defined in the contract.






2. 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






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






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






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






6. 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.






7. 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






8. 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






9. 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






10. 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






11. 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






12. 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






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






14. Unauthorized release of information






15. 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.






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






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






18. A nonprofit integrated delivery system






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






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






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






22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






24. 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






25. 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






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






27. Medical services provided on an outpatient basis






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






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






30. 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






31. 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






32. 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






33. 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






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






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






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






37. 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.






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






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






40. 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






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






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






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






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






45. 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






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






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






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






49. 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






50. A rule - condition - or requirement