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






2. 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






3. 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






4. 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






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






6. 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






7. 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






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






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






10. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






11. 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.






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






13. 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






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






15. The amount of actual money available to the medical practice






16. 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)






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






18. 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






19. Medical services provided on an outpatient basis






20. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






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






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






24. 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






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






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






27. A nonprofit integrated delivery system






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






29. 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.






30. 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.






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






32. 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.






33. 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.






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






35. 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






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






37. 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.






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






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






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






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






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






43. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






44. 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.






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






46. 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






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






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






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