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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 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






2. 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






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






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






5. 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






6. Verbal or written agreement that gives approval to some action - situation - or statement.






7. 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.






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






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






10. The condition of being secluded from the presence or view of others.






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






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






13. 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






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






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






16. 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






17. 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.






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






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. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






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






22. 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.






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






24. The condition of being secluded from the presence or view of others.






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






26. 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






27. 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






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






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






30. 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






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


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






33. 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






34. Health Information Portability and Accountability Act






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






36. 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






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






38. 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






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






40. A patient claim is eligible for medicare and medicaid






41. 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.






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






43. A rule - condition - or requirement






44. 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.






45. 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






46. 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






47. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






48. 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






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






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