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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 medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






2. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






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






5. 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)






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






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






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






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






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






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






12. 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






13. 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.






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


15. A rule - condition - or requirement






16. 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






17. 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






18. 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






19. 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.






20. 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.






21. 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






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






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






24. Medical services provided on an outpatient basis






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






26. A patient claim is eligible for medicare and medicaid






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






28. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






29. 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






30. 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






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






32. 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






33. American Medical Association






34. 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






35. 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






36. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






37. 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)






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






39. 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






40. 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






41. 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.






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






43. Individually identifiable health information






44. 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.






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






46. 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






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






48. 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






49. Individually identifiable health information






50. 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