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






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






3. 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.






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






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






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






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






8. A patient claim is eligible for medicare and medicaid






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






10. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






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






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






14. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






15. 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






16. 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






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. 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






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






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






21. 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.






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






23. 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






24. A rule - condition - or requirement






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






26. 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






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






28. 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






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






30. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






31. 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)






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






33. Health Information Portability and Accountability Act






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






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






36. A nonprofit integrated delivery system






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






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






39. American Medical Association






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






41. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






43. 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






44. A patient claim is eligible for medicare and medicaid






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






46. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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






48. 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






49. 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






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