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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. 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






2. 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






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






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






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






6. 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






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






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






9. 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






10. Medical services provided on an outpatient basis






11. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






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. 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






15. The dates of healthcare services were provided to the beneficiary






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






17. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






18. 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






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






20. 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






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






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






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






24. 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






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






26. 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






27. 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.






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






29. A nonprofit integrated delivery system






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






31. 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






32. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






34. 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.






35. 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






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






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






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






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






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






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






42. 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.






43. 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.






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






45. 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






46. 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.






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






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






49. 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.






50. The dates of healthcare services were provided to the beneficiary