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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 managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






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. 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.






6. 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.






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






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






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






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






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






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






13. American Medical Association






14. 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






15. 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






16. Individually identifiable health information






17. Unauthorized release of information






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






19. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






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






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






23. A nonprofit integrated delivery system






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 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






26. 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






27. 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






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






29. 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






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






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






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






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






34. Standards of conduct generally accepted as a moral guide for behavior.






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






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






37. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






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






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






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






41. 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






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






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






44. 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






45. 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






46. 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






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






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






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






50. A rule - condition - or requirement