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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. 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






2. Health Information Portability and Accountability Act






3. 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.






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






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






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






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






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






10. 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






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






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






13. 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






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






15. Billing for services not performed






16. 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.






17. 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






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






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






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






21. 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






22. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






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






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






26. 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






27. 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






28. 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






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






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






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






32. 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.






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






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






35. 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






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






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






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






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






40. 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.






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






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






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






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






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






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






47. A nonprofit integrated delivery system






48. Individually identifiable health information






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






50. 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