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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. 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.






2. 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






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






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






5. 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






6. 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.






7. 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.






8. Medical services provided on an outpatient basis






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






10. 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






11. A nonprofit integrated delivery system






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






13. 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






14. 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






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






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






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






18. 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






19. 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






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






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






22. Health Information Portability and Accountability Act






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






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






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






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






27. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






28. 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)






29. A rule - condition - or requirement






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






31. 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.






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






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






34. 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






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






36. Billing for services not performed






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






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






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






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






41. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






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






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






44. 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.






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






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






47. 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






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






49. 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






50. Billing for services not performed