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






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






3. 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






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






5. 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






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. 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






8. 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






9. 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






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






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






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






13. 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.






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






15. Individually identifiable health information






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






17. 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






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






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






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






21. 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






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






23. 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






24. 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






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






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






27. Medical services provided on an outpatient basis






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






29. 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.






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






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






32. 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.






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






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






35. An organization of provider sites with a contracted relationship that offer services






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






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






38. 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.






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






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






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






42. 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






43. 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.






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






45. 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






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






47. 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






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






49. A rule - condition - or requirement






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