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






2. A nonprofit integrated delivery system






3. 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






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






5. Is a provider who sends the patients for testing or treatment






6. A list of the amount to be paid by an insurance company for each procedure service






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






8. 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






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






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. 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






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






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






14. Customs - rules of conduct - courtesy - and manners of the medical profession






15. 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






16. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






18. 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.






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






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






22. Individually identifiable health information






23. 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






24. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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 organization of provider sites with a contracted relationship that offer services






27. 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






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






29. 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.






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






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






32. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






34. 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.






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






36. 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)






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






38. 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.






39. 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






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






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






42. 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






43. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






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






46. 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






47. 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.






48. 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.






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






50. 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