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






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






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






4. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






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






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






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






9. 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.






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






11. 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






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






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






14. 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.






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






16. 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.






17. Billing for services not performed






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






19. 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






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






21. Medicare's method of paying acute care hospitals for inpatient care






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






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






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






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






26. 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






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






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






29. 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.






30. Medicare's method of paying acute care hospitals for inpatient care






31. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






32. An intentional misrepresentation of the facts to deceive or mislead another.






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






34. 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






35. 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.






36. 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






37. 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.






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






39. Health Information Portability and Accountability Act






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






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






42. 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






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






44. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






45. A patient claim is eligible for medicare and medicaid






46. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






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






49. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






50. A nonprofit integrated delivery system