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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 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






2. 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.






3. 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






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






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






6. 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






7. A clinic that is owned by the HMO and the physicians are employees of the HMO






8. 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






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






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






11. 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.






12. 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.






13. 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.






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. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






17. 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






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






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






20. 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






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






22. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






23. Billing for services not performed






24. 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.






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






26. Customs - rules of conduct - courtesy - and manners of the medical profession






27. 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






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






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






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






31. 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






32. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






33. 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.






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






35. 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.






36. A clinic that is owned by the HMO and the physicians are employees of the HMO






37. 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






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






39. Medical services provided on an outpatient basis






40. A nonprofit integrated delivery system






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






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






43. 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






44. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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. 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. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






48. A rule - condition - or requirement






49. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






50. 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