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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 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






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






3. 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






4. 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






5. 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






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






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






8. American Medical Association






9. 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






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






11. 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






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






13. 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)






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






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






16. Individually identifiable health information






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






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






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






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






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






22. Unauthorized release of information






23. 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






24. 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






25. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






26. 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.






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






28. 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)






29. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






30. Health Information Portability and Accountability Act






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






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






33. 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






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






35. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






36. 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






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






38. 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






39. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






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






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






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






44. 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






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






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






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






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






49. 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






50. 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