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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 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)






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






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






4. 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






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






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






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






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






9. Verbal or written agreement that gives approval to some action - situation - or statement.






10. 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.






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






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






13. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






14. 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






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






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






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






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






19. 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.






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






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

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






23. 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






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






25. 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)






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






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






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






29. Billing for services not performed






30. 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






31. 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






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






33. 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






34. A clinic that is owned by the HMO and the physicians are employees of the HMO






35. 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






36. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






38. 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.






39. 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






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






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






42. 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






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






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






46. 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






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






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






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






50. 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







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