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






2. 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






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






4. Billing for services not performed






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






6. 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






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






8. 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.






9. 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






10. 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






11. 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






12. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






30. 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






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






32. 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






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






34. Medical services provided on an outpatient basis






35. 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.






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






37. 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






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






39. 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






40. 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.






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






42. 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






43. 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






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






45. 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






46. 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.






47. 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.






48. 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






49. 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






50. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare