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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 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.






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






3. 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






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






5. 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






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






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






8. 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






9. 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.






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






11. 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






12. Billing for services not performed






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






14. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






15. 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






16. American Medical Association






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

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






19. A nonprofit integrated delivery system






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






21. 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






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






23. 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






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






25. 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.






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






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






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






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






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






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






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






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






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






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






36. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






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






39. 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)






40. 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






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






42. 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






43. 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






44. 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






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






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






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






48. 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.






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






50. American Medical Association







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