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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 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.






2. 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.






3. 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






4. 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.






5. Billing for services not performed






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






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






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






9. 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






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






11. A review of the need for inpatient hospital care - completed before the actual admission






12. 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






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






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






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






16. 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






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






18. 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






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






20. 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






21. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






23. 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






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






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






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






27. Is a provider who sends the patients for testing or treatment






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






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






30. 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






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






32. Individually identifiable health information






33. 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.






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






35. 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






36. 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






37. 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






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






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






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






41. 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






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






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






44. 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






45. 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






46. 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






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






48. 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






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






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







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