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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. 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






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






3. Unauthorized release of information






4. 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.






5. 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.






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






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






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






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






10. 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






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






12. 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.






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






14. American Medical Association






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






16. 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






17. 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






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






19. 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






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






21. 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






22. 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






23. 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






24. 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.






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






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






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






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






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






30. 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






31. Integrating benefits payable under more than one health insurance.






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






33. 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






34. Integrating benefits payable under more than one health insurance.






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






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






37. 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.






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






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






40. 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






41. 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






42. 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






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






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






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






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






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






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






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






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







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