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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 member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






3. 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






4. Medical services provided on an outpatient basis






5. A rule - condition - or requirement






6. 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.






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






8. Billing for services not performed






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






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






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






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






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






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






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






17. A nonprofit integrated delivery system






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






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






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

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






22. 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






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






24. 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.






25. 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.






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






27. Individually identifiable health information






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






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






30. 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






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






32. Medical services provided on an outpatient basis






33. 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






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






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






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






37. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






39. 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






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






41. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






42. 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.






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






44. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






46. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






47. 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






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






49. 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






50. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations