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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. 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






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 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






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






5. Billing for services not performed






6. Unauthorized release of information






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






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






9. 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






10. 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






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






12. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






14. 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






15. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






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






18. 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






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






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. 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






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






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






24. 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






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






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






27. 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






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






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






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






31. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






32. 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)






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






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






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






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






37. Medical services provided on an outpatient basis






38. Health Information Portability and Accountability Act






39. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






40. 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.






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






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






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






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






45. Health Information Portability and Accountability Act






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






47. 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.






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






49. 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






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