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






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






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






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






5. 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)






6. 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






7. 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.






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






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






10. 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






11. Health Information Portability and Accountability Act






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






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






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






15. 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






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






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






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






19. 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






20. Medicare's method of paying acute care hospitals for inpatient care






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






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






23. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






24. A rule - condition - or requirement






25. 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






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






27. 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






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






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






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






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






32. 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






33. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






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. 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






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. 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.






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






39. 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.






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






41. 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.






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






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






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. 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.






46. 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






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






48. Is the provider who renders a service to a patient






49. 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)






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