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






2. A rule - condition - or requirement






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






4. 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.






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






7. 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






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






9. Health Information Portability and Accountability Act






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






11. 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






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






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






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






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






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






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






18. 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.






19. 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






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






21. 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






22. 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






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






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






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






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






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






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






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






30. 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.






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






32. 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






33. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






34. A provision that apples when a person is covered under more than one group medical program






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






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






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






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






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






40. 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.






41. 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.






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






43. 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






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






45. 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






46. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






47. 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






48. 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)






49. A rule - condition - or requirement






50. 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