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






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






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






4. 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.






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






6. A rule - condition - or requirement






7. 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






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






9. 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






10. 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






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






12. 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






13. A rule - condition - or requirement






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






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






16. 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






17. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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






19. 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






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






21. 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.






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






23. 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






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






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






26. 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.






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






28. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






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






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






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






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






34. 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.






35. 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






36. 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






37. 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






38. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






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






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






42. 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






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






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






45. 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






46. 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)






47. 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.






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






49. Medical services provided on an outpatient basis






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