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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. Medical services provided on an outpatient basis






2. 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.






3. 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






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






5. 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






6. The period of time that payment for Medicare inpatient hospital benefits are available






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






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






9. Unauthorized release of information






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. 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






12. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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






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






15. 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






16. 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)






17. 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






18. 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






19. 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






20. 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






21. 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






22. A rule - condition - or requirement






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






24. 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






25. A willful act by an employee of taking possession of an employer's money






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






27. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






28. 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.






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






30. 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






31. 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






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






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






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






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






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






37. 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






38. Individually identifiable health information






39. 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






40. A willful act by an employee of taking possession of an employer's money






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






42. A patient claim is eligible for medicare and medicaid






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






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






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






46. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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






48. 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






49. 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






50. 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