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






2. Individually identifiable health information






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






4. 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.






5. 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






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






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






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






9. Customs - rules of conduct - courtesy - and manners of the medical profession






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






11. 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






12. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






13. 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






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






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






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






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






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






20. 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






21. A patient claim is eligible for medicare and medicaid






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






23. 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






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






25. 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






26. Customs - rules of conduct - courtesy - and manners of the medical profession






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






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. The maximum amount a plan pays for a covered service






31. 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






32. 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






33. Medical services provided on an outpatient basis






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






35. 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






36. 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






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






38. 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






39. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






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






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






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






43. Billing for services not performed






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






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






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






47. A patient claim is eligible for medicare and medicaid






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






49. 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.






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