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






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






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






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






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






6. 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






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






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






9. A monthly fee paid by the insured for specific medical insurance coverage






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






11. Individually identifiable health information






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






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






14. 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






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






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






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






18. 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






19. 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






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






21. 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






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






23. 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






24. 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.






25. The period of time that payment for Medicare inpatient hospital benefits are available






26. 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






27. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






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






30. 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






31. A nonprofit integrated delivery system






32. 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






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






34. 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.






35. A rule - condition - or requirement






36. 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.






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






38. 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






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






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






41. 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






42. 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.






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






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






45. 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






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






47. An intentional misrepresentation of the facts to deceive or mislead another.






48. A patient claim is eligible for medicare and medicaid






49. 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






50. 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







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