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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. Health Information Portability and Accountability Act






2. 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






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






4. A nonprofit integrated delivery system






5. 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






6. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






7. A patient claim is eligible for medicare and medicaid






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






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

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10. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






11. The amount of actual money available to the medical practice






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






13. 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.






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






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






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






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






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






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






20. 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






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






22. 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






23. Medical services provided on an outpatient basis






24. 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






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






26. Medical services provided on an outpatient basis






27. 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.






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






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. 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






31. 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






32. 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.






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






34. 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






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






36. 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.






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






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






39. A rule - condition - or requirement






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






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






42. 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






43. 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






44. American Medical Association






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






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






47. 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






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






49. 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.






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







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