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






2. A rule - condition - or requirement






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






4. 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.






5. 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






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






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






8. 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.






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






10. 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






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






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






13. 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






14. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






15. American Medical Association






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






17. 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.






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






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






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






21. Individually identifiable health information






22. Unauthorized release of information






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






24. 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.






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






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






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






28. 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






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






30. 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






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






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






33. Health Information Portability and Accountability Act






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

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35. 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.






36. 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)






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






38. Billing for services not performed






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






40. 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






41. 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






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






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






44. 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






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






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






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






48. Medical services provided on an outpatient basis






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






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