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






3. Individually identifiable health information






4. 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






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






6. Unauthorized release of information






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






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






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






10. 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.






11. 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






12. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






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






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






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






16. 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






17. 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






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






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






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






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






22. 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






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






24. 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.






25. 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






26. 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






27. 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






28. Health Information Portability and Accountability Act






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






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

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






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






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






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






35. 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






36. 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






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






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






39. 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.






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






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






42. 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.






43. 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)






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






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






46. 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






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






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






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






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.