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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. 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






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






3. Unauthorized release of information






4. 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






5. 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






6. 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)






7. 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






8. 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






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






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






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






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






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






14. 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.






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






16. 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






17. 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)






18. A rule - condition - or requirement






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






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






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






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






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






25. 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.






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






27. Individually identifiable health information






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






29. Medical services provided on an outpatient basis






30. 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






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






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






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






34. American Medical Association






35. Is a provider who sends the patients for testing or treatment






36. 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






37. 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






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






39. 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






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






41. 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






42. 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.






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






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






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






46. 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.






47. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






48. 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






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






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