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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. 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






3. 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






4. 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






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






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






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






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






9. 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






10. 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






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






12. 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.






13. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






14. 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






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






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






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






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






19. 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






20. 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






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






22. 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






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






24. 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






25. 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.






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






27. A nonprofit integrated delivery system






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






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






30. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






31. American Medical Association






32. 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






33. A rule - condition - or requirement






34. 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






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






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






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






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






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






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






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






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






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






44. Billing for services not performed






45. Health Information Portability and Accountability Act






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






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






48. 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






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. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment