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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. Individually identifiable health information






2. 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






3. A rule - condition - or requirement






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






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






6. A patient claim is eligible for medicare and medicaid






7. 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






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






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






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






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






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






13. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






14. 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






15. 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.






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






17. 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.






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






19. A rule - condition - or requirement






20. 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.






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






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






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






24. 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.






25. 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






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






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






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






29. 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






30. The transmission of information between two parties to carry out financial or administrative activities related to health care.






31. 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






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






33. 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






34. 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






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. 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.






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






38. 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.






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






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

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






42. 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






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






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






45. Health Information Portability and Accountability Act






46. 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.






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






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






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






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