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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. 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






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






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






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






5. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






7. 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.






8. A rule - condition - or requirement






9. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






10. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






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






12. 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






13. 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






14. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






15. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






17. 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






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






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






20. 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






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






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






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






24. 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.






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






26. Health Information Portability and Accountability Act






27. Unauthorized release of information






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






29. 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






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






31. Billing for services not performed






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






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






34. 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






35. 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






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






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






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






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






41. 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






42. 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






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






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






45. A nonprofit integrated delivery system






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






47. 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






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






49. 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






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