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






2. 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






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






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






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






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






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






8. 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.






9. 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






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






11. 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






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






13. 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.






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






15. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






16. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






17. A patient claim is eligible for medicare and medicaid






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






19. 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






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






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






22. 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






23. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






24. 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)






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






26. 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






27. 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






28. 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






29. 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






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






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






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






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






34. 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.






35. 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






36. Unauthorized release of information






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






38. 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.






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






40. Medical services provided on an outpatient basis






41. 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






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






43. 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.






44. 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






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






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






47. 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






48. 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






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






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