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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. Medical staff member who is legally responsible for the care and treatment given to a patient.






2. A nonprofit integrated delivery system






3. 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






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






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






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






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






8. 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






9. 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






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






11. 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.






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






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






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






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






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






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






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






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






20. American Medical Association






21. 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






22. Medicare's method of paying acute care hospitals for inpatient care






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






24. 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






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






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






27. 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






28. 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.






29. 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






30. 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






31. 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






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






33. 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






34. 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






35. 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.






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






37. 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






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






40. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






41. 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






42. 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)






43. A provision that apples when a person is covered under more than one group medical program






44. A nonprofit integrated delivery system






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






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






47. 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






48. 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.






49. 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






50. 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.