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






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






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






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






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






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






7. 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






8. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






10. 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.






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






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






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






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






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






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






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






18. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






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






21. 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.






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






23. A nonprofit integrated delivery system






24. 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






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






26. 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






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






28. 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.






29. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






30. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






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






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






34. 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






35. 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






36. 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






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






38. 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






39. The amount of actual money available to the medical practice






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






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






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






43. 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






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






45. Health Information Portability and Accountability Act






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






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






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






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






50. 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.