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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. 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.






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






3. 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






4. 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






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






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






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






8. 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






9. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






10. Medical services provided on an outpatient basis






11. 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






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






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






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






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






16. Customs - rules of conduct - courtesy - and manners of the medical profession






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






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






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






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






21. 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)






22. 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






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






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






25. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






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






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






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






30. 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.






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






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. 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






34. A rule - condition - or requirement






35. 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.






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






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






38. American Medical Association






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






40. 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






41. Unauthorized release of information






42. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






43. 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






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






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






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






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






48. 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






49. 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






50. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.