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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. The maximum amount a plan pays for a covered service






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






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






4. 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






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






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






7. Health Information Portability and Accountability Act






8. 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.






9. 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






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. 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






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






13. 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






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






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






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






17. Health Information Portability and Accountability Act






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






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






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






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






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






23. 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






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






25. 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.






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






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






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






29. 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






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






31. Unauthorized release of information






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






33. 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






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






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






36. American Medical Association






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. Individually identifiable health information






39. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






40. 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






41. 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.






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






43. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






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






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






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






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






48. A nonprofit integrated delivery system






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






50. 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