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






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






3. 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






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






5. 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






6. 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






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






8. 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






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






10. 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






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






12. 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






13. Individually identifiable health information






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






15. 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






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






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






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






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






20. A rule - condition - or requirement






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






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






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






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






25. 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






26. Health Information Portability and Accountability Act






27. 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.






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






29. 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






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






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






32. 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






33. 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






34. A nonprofit integrated delivery system






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

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






37. 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






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






39. 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






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






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






42. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






44. 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.






45. 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)






46. A patient claim is eligible for medicare and medicaid






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






48. 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






49. 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






50. Unauthorized release of information