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






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






4. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






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






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






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






8. 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.






9. What the insurance company will consider paying for as defined in the contract.






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






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






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






14. 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






15. Unauthorized release of information






16. A rule - condition - or requirement






17. 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.






18. 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






19. 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






20. Health Information Portability and Accountability Act






21. 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






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






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






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






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






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






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






28. 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






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






30. 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






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






32. 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.






33. 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.






34. 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






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






36. 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






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






38. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






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






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






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






43. 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.






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






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






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






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






48. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






49. 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






50. 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