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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 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






2. 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.






3. 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






4. 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.






5. 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.






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






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






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






9. 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






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






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






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






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






14. 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






15. 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






16. 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






17. Individually identifiable health information






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






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






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






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






23. 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






24. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






25. 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






26. 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






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






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






29. A patient claim is eligible for medicare and medicaid






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






31. 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.






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






33. 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)






34. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






35. 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






36. 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






37. 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






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






39. Health Information Portability and Accountability Act






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






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






42. American Medical Association






43. 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






44. A patient claim is eligible for medicare and medicaid






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






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






47. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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48. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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






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