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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. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






2. 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.






3. 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.






4. 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






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






6. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






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






9. 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






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






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






12. 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






13. 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






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






15. 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






16. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






17. A patient claim is eligible for medicare and medicaid






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






19. 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






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






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






22. Unauthorized release of information






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






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. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






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






27. 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






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. 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.






30. 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






31. 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.






32. 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






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






34. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






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






37. American Medical Association






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






39. 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






40. 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






41. The dates of healthcare services were provided to the beneficiary






42. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






44. 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.






45. 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.






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






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






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






49. A rule - condition - or requirement






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