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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. 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.






2. 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






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






4. 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






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






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






7. 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






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






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






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






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






12. 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






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






14. 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






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






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






17. 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.






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






19. A nonprofit integrated delivery system






20. 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






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






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






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






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






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






26. 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.






27. 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






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






29. 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.






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






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






32. 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






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






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






35. 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






36. 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






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






38. Individually identifiable health information






39. Medical services provided on an outpatient basis






40. 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






41. 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






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






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






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






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






46. 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






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. 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






49. 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)






50. 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