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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 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






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






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






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






5. 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.






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






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






8. 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






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






10. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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






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






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






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






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






16. A nonprofit integrated delivery system






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






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






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






20. 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)






21. 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






22. Health Information Portability and Accountability Act






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






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






25. 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






26. 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.






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






28. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






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






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






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






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






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. The maximum amount a plan pays for a covered service






35. 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






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






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






38. Individually identifiable health information






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






40. 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






41. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






42. 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.






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






44. American Medical Association






45. A nonprofit integrated delivery system






46. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






47. 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)






48. 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.






49. 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.






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