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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 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






2. 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






3. 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






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






5. 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






6. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






7. 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






8. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






9. 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






10. 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






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






12. 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






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






14. 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






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






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






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






18. Unauthorized release of information






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






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






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






22. 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)






23. 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.






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






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






26. Individually identifiable health information






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






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






29. 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.






30. 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






31. A rule - condition - or requirement






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






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

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






35. 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.






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






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






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






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






40. Medical services provided on an outpatient basis






41. 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






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






43. 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






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






45. 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.






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






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






48. 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






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






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