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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. The amount of actual money available to the medical practice






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






3. 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






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






5. 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






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






7. Unauthorized release of information






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

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






10. 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.






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






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






13. 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






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






15. A health insurance enrollee chooses to see an out of network provider without authorization






16. 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.






17. A list of the amount to be paid by an insurance company for each procedure service






18. A list of the amount to be paid by an insurance company for each procedure service






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






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






22. 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






23. A patient claim is eligible for medicare and medicaid






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






25. 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






26. A structure for classifying outpatient services and procedures for purpose of payment






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






28. Individually identifiable health information






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






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






31. 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






32. 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






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






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






36. A rule - condition - or requirement






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






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






39. The maximum amount a plan pays for a covered service






40. 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






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






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






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






44. 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.






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






46. 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






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






49. A nonprofit integrated delivery system






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