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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. 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






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






3. 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






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






5. 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.






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






7. 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






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






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






10. 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






11. 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






12. 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






13. Standards of conduct generally accepted as a moral guide for behavior.






14. 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






15. 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






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






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






18. 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.






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

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20. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






21. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






22. 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






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






24. 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






25. 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






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






27. A nonprofit integrated delivery system






28. 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






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






30. A patient claim is eligible for medicare and medicaid






31. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






32. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






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






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






35. 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






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






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






38. Individually identifiable health information






39. 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






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






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






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






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






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






45. 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






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






47. 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






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






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






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