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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. 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






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






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






4. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






5. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






7. A patient claim is eligible for medicare and medicaid






8. 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






9. 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






10. 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






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






12. Unauthorized release of information






13. 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.






14. 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






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






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






17. 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






18. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






19. 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






20. 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.






21. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






22. 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.






23. 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.






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






25. 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






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






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






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






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






30. 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.






31. What the insurance company will consider paying for as defined in the contract.






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






33. Unauthorized release of information






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






35. 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






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






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






38. 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






39. Individually identifiable health information






40. 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.






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






42. 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






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






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






45. Health Information Portability and Accountability Act






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






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






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






49. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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