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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 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






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






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






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






6. 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






7. 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






8. 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






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






10. 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






11. 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.






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






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






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






15. 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






16. A clinic that is owned by the HMO and the physicians are employees of the HMO






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. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






19. 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






20. 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






21. 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)






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






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






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






25. 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.






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






27. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






28. 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.






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






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






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






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






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






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






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






36. Someone who is eligible for or receiving benefits under an insurance policy or plan






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






38. 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.






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






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






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






42. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






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






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






45. A monthly fee paid by the insured for specific medical insurance coverage






46. 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






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






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






49. The period of time that payment for Medicare inpatient hospital benefits are available






50. 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.