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






3. 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






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






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






6. 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






7. 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.






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






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






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






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






12. 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






13. Unauthorized release of information






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






15. 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






16. 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.






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






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






19. 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






20. 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






21. 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.






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






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






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






25. 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






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






27. 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






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






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






30. 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.






31. 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






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






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






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






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






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






37. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






38. 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.






39. American Medical Association






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






41. 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






42. Health Information Portability and Accountability Act






43. 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






44. 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






45. 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






46. 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.






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






48. 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)






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






50. Unauthorized release of information