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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 nonprofit integrated delivery system






2. Approval or consent by a primary physician for patient referral to ancillary services and specialists






3. 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






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






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






6. A rule - condition - or requirement






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






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






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






10. 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






11. Unauthorized release of information






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






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






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






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






16. 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






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






18. 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






19. 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






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






21. What the insurance company will consider paying for as defined in the contract.






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






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






24. 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.






25. 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






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






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






28. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






29. 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






30. 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.






31. 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.






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






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






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






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






36. 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






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






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






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






40. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






41. 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






42. A patient claim is eligible for medicare and medicaid






43. 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.






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






45. 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.






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






47. 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.






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






49. A rule - condition - or requirement






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