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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. 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






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






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






4. 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






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






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






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






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






9. Individually identifiable health information






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






11. 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






12. 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.






13. 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






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






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






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






17. An intentional misrepresentation of the facts to deceive or mislead another.






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






19. 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.






20. 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)






21. 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






22. 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






23. A nonprofit integrated delivery system






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






25. 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.






26. 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






27. 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.






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






29. 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






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






31. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






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






34. 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






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






36. 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.






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






38. Standards of conduct generally accepted as a moral guide for behavior.






39. 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






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






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






42. 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






43. Someone who is eligible for or receiving benefits under an insurance policy or plan






44. 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






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






46. Integrating benefits payable under more than one health insurance.






47. 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.






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






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






50. 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