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






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






3. A clinic that is owned by the HMO and the physicians are employees of the HMO






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






5. 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






6. 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.






7. 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






8. 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






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






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






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






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






14. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






15. 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.






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






17. 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






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






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. 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






21. 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






22. 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






23. 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






24. 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






25. 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






26. A patient claim is eligible for medicare and medicaid






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






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






29. 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






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






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






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






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






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






35. 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






36. 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






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






38. 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






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






40. 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.






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






42. 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






43. 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






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






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






46. 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






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






48. 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.






49. Health Information Portability and Accountability Act






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