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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 protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






3. 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






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






5. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






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






8. 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.






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. 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






11. 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.






12. Individually identifiable health information






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






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






15. 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






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






17. 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






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






19. 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






20. Health Information Portability and Accountability Act






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






22. 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






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






24. 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






25. 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






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 structure for classifying outpatient services and procedures for purpose of payment






28. 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.






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






30. 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.






31. 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






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






33. 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






34. 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






35. 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.






36. Unauthorized release of information






37. 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






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


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






40. 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






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






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






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






44. Unauthorized release of information






45. 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






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






48. A rule - condition - or requirement






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






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