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






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






3. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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4. 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






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






6. 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






7. Customs - rules of conduct - courtesy - and manners of the medical profession






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






9. American Medical Association






10. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






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






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






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






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






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






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






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






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






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






21. Health Information Portability and Accountability Act






22. 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.






23. Individually identifiable health information






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






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






26. 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






27. 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.






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






29. 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






30. 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






31. 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.






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






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






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






35. 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






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






37. 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






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






39. 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






40. Unauthorized release of information






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






42. 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.






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






44. 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






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






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






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






49. A patient claim is eligible for medicare and medicaid






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