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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. 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






2. 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






3. A patient claim is eligible for medicare and medicaid






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






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






6. Unauthorized release of information






7. 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






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






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






10. 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






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






12. 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






13. Integrating benefits payable under more than one health insurance.






14. 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






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






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






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






18. 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






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






20. 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






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






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






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






24. Individually identifiable health information






25. 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.






26. 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.






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






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






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






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






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






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






33. 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






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






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






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






37. 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.






38. 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.






39. 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






40. Verbal or written agreement that gives approval to some action - situation - or statement.






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






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






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






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






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






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


48. 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






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