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






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






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






4. 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






5. 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.






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






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






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






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






10. 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






11. 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






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






13. 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)






14. 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






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






16. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






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






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






21. 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






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






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






24. 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






25. 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






26. Unauthorized release of information






27. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






28. 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






29. 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.






30. 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






31. 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






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






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






34. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






35. 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)






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






37. 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






38. Health Information Portability and Accountability Act






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






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






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






42. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






44. 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






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






46. 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.






47. 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






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






49. A rule - condition - or requirement






50. 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.