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






2. Health Information Portability and Accountability Act






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






4. 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






5. Someone who is eligible for or receiving benefits under an insurance policy or plan






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






7. 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






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






9. 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






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






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






12. Health Information Portability and Accountability Act






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

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






15. 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.






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






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






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






19. 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






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






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






22. American Medical Association






23. Individually identifiable health information






24. 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






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






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






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






28. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






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






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






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






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






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






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






35. A nonprofit integrated delivery system






36. 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.






37. 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.






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






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






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






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






42. 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






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






44. 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






45. 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.






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






47. A patient claim is eligible for medicare and medicaid






48. 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.






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






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