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






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






3. 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.






4. 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)






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






6. What the insurance company will consider paying for as defined in the contract.






7. 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






8. A rule - condition - or requirement






9. 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.






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






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






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






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






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






15. 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






16. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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 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






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






20. 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






21. A nonprofit integrated delivery system






22. 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






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






24. 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






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






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






27. 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.






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






29. 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






30. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






32. 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.






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






34. 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






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






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






37. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






39. 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






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






41. Individually identifiable health information






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






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






44. 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.






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






46. 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.






47. Health Information Portability and Accountability Act






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






49. 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






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