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






2. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






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






4. 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.






5. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






7. Unauthorized release of information






8. Medical services provided on an outpatient basis






9. 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






10. 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






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






12. 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






13. 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






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






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

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

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






18. 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.






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






20. 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






21. A patient claim is eligible for medicare and medicaid






22. 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






23. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






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






26. 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






27. 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.






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






29. A rule - condition - or requirement






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






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






32. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






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






34. 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






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






36. 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






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






38. 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)






39. 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.






40. The maximum amount a plan pays for a covered service






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






42. The dates of healthcare services were provided to the beneficiary






43. 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.






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






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






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






47. 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






48. 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






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






50. 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