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






2. Health Information Portability and Accountability Act






3. 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.






4. 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.






5. 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






6. 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






7. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






10. 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






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






12. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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13. 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






14. 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.






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






16. 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






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






18. 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






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






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






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






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






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






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






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






26. 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






27. 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






28. A rule - condition - or requirement






29. 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






30. 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






31. 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






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






33. 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)






34. 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






35. 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






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






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






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






39. 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






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






41. Individually identifiable health information






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






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






44. Billing for services not performed






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






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. 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






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






50. 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







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