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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. 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






2. 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.






3. Individually identifiable health information






4. Health Information Portability and Accountability Act






5. 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






6. 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)






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






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

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






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






12. 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.






13. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






15. 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.






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






17. 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.






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






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






20. American Medical Association






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






22. 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






23. 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






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






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. Integrating benefits payable under more than one health insurance.






27. 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.






28. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






30. 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






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






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






33. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






35. 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






36. 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






37. Billing for services not performed






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






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






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






41. The dates of healthcare services were provided to the beneficiary






42. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






44. 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






45. 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






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






47. 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






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






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






50. 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.