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






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






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






4. 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






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






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






7. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






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






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






10. 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






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






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






13. 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






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 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






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






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






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






19. 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






20. 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






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






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






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






24. 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






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






26. 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






27. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






28. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






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






30. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






32. 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






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






34. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






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






37. 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






38. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






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






40. 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.






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






42. A patient claim is eligible for medicare and medicaid






43. 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






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






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






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






48. 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.






49. 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






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







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