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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 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






2. 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)






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






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. 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






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






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






8. 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






9. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






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






12. A patient claim is eligible for medicare and medicaid






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






14. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






15. 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






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






17. 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






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






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






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






21. Individually identifiable health information






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






23. 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






24. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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

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26. Medical services provided on an outpatient basis






27. 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.






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






29. A patient claim is eligible for medicare and medicaid






30. 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






31. 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






32. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






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






35. Standards of conduct generally accepted as a moral guide for behavior.






36. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






37. Standards of conduct generally accepted as a moral guide for behavior.






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






39. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






40. 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






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






42. 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






43. 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






44. 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






45. 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






46. The transmission of information between two parties to carry out financial or administrative activities related to health care.






47. 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






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






49. 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






50. 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