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






3. 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.






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






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






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






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






8. 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.






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






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






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






13. 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






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






15. 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






16. 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






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






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






19. 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)






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






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






22. 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






23. Billing for services not performed






24. 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






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






26. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






27. A patient claim is eligible for medicare and medicaid






28. 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






29. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






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






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






33. The amount of actual money available to the medical practice






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






35. 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






36. 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






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






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






39. Someone who is eligible for or receiving benefits under an insurance policy or plan






40. Unauthorized release of information






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






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






43. A nonprofit integrated delivery system






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






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






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






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






48. 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






49. 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






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.