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






2. 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.






3. 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






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






5. American Medical Association






6. Health Information Portability and Accountability Act






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






8. 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






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






10. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






11. 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






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






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






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






15. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






16. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






17. 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.






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






19. 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






20. 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






21. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






22. 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






23. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






24. 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






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






26. 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






27. 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.






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






29. 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






30. 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






31. Unauthorized release of information






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






33. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






34. 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






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






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






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






38. 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






39. 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






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






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






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






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






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






45. 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






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






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






48. 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






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






50. 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