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






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






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






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






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






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






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






8. 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






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






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






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






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






13. Unauthorized release of information






14. Health Information Portability and Accountability Act






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






16. 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.






17. Health Information Portability and Accountability Act






18. Unauthorized release of information






19. 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






20. 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






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






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






23. A patient claim is eligible for medicare and medicaid






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






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






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






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






28. 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






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






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






31. 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






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






33. Billing for services not performed






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






35. 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






36. Billing for services not performed






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






38. 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.






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






40. 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






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






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






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






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






45. Medical services provided on an outpatient basis






46. 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






47. 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






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






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