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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. Integrating benefits payable under more than one health insurance.






2. 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






3. 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






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






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






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






7. 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.






8. 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






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






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






11. 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






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






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






14. 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






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






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






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






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






19. The maximum amount a plan pays for a covered service






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






21. 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






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






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






24. Billing for services not performed






25. 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






26. 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






27. 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






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






29. 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






30. 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.






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






32. 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.






33. Individually identifiable health information






34. 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






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






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






37. A nonprofit integrated delivery system






38. The condition of being secluded from the presence or view of others.






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






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






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






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






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






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






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






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






47. The condition of being secluded from the presence or view of others.






48. 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.






49. 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






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