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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 dates of healthcare services were provided to the beneficiary






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






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. 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.






5. Medical services provided on an outpatient basis






6. Unauthorized release of information






7. 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






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






9. 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






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






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






12. 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






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






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






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






16. 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






17. American Medical Association






18. 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






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






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






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






22. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






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






25. 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






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






27. 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






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






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






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






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. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






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






35. Health Information Portability and Accountability Act






36. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






37. 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






38. 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






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






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






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






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






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






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






45. Health Information Portability and Accountability Act






46. 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






47. 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






48. 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






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






50. 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