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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 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






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






3. Individually identifiable health information






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






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






6. Unauthorized release of information






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






8. 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






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






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






11. 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






12. 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






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






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






15. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






16. 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)






17. Individually identifiable health information






18. 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.






19. 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






20. Billing for services not performed






21. 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






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






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






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






25. 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






26. American Medical Association






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






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






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






31. Billing for services not performed






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






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






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






35. 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






36. 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






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






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






39. 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






40. 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






41. 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






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






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






44. 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.






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






47. Medical services provided on an outpatient basis






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






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






50. 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