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






2. 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.






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






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






5. 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






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






7. 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






8. 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






9. 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






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






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






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






13. A nonprofit integrated delivery system






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






15. 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






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






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






18. 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






19. Is the provider who renders a service to a patient






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






21. 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.






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






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






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






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






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






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






28. 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






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






30. 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






31. A patient claim is eligible for medicare and medicaid






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






33. 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.






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






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






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






37. 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






38. 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






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






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






41. 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






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






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. 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






45. 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)






46. 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






47. 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






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






49. 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






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







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