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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 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.






2. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






3. 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






4. 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






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






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






7. 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






8. 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






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






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. 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






12. A nonprofit integrated delivery system






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






14. 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.






15. The maximum amount a plan pays for a covered service






16. Medical services provided on an outpatient basis






17. Unauthorized release of information






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






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






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






21. 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






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






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






24. 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






25. American Medical Association






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






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






28. Unauthorized release of information






29. 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.






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






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






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






33. 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






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






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






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






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. 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.






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






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






42. 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






43. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






44. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






45. A provision that apples when a person is covered under more than one group medical program






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

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48. 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.






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






50. 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