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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. Individually identifiable health information






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






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






4. Health Information Portability and Accountability Act






5. Health Information Portability and Accountability Act






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






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






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






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






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






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






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






13. 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






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






15. 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






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






17. 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






18. 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






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






20. 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.






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






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






24. Is a provider who sends the patients for testing or treatment






25. 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






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






27. A structure for classifying outpatient services and procedures for purpose of payment






28. 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






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






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






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






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






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






34. 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






35. Billing for services not performed






36. 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






37. A review of the need for inpatient hospital care - completed before the actual admission






38. Medical services provided on an outpatient basis






39. Individually identifiable health information






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






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






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






43. 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






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






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






46. A structure for classifying outpatient services and procedures for purpose of payment






47. 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






48. 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






49. Is a provider who sends the patients for testing or treatment






50. 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.