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






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






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






4. 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






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






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






7. 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.






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






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






10. 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






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






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






13. The maximum amount a plan pays for a covered service






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






15. 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.






16. American Medical Association






17. 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






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






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






20. 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






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






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






23. 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






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






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






26. 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






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






28. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






29. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






30. American Medical Association






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






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






33. 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






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






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






37. 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






38. 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






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






40. 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.






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






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






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






44. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






45. 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.






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






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






49. A nonprofit integrated delivery system






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