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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. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






2. Unauthorized release of information






3. 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.






4. 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






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






6. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






7. Medical services provided on an outpatient basis






8. 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






9. 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






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






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






12. 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






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






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






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






17. 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.






18. 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






19. 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






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






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






22. American Medical Association






23. A nonprofit integrated delivery system






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






25. 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






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






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






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






29. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






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






31. 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.






32. 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






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






34. 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






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






36. 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






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






38. Health Information Portability and Accountability Act






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






40. 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






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






42. 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.






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






44. A rule - condition - or requirement






45. 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






46. 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.






47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






48. A health insurance enrollee chooses to see an out of network provider without authorization






49. 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






50. A willful act by an employee of taking possession of an employer's money