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






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






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. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






6. 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






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






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






9. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






10. 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.






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






12. 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.






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






14. 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






15. 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






16. Individually identifiable health information






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






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






19. A nonprofit integrated delivery system






20. A rule - condition - or requirement






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






22. 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






23. 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






24. Health Information Portability and Accountability Act






25. American Medical Association






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






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






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






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






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






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






32. 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






33. 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.






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






35. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






36. 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






37. 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.






38. Medical services provided on an outpatient basis






39. 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






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






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






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






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






44. Unauthorized release of information






45. 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






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






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






48. 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.






49. 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






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