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






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






4. 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






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






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






7. 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






8. 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)






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






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






11. 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






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






13. 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






14. 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






15. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






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






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






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






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

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






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






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






24. A nonprofit integrated delivery system






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






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






27. 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






28. 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






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






30. Health Information Portability and Accountability Act






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






32. 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






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






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






35. 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






36. 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






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






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






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. 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






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






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






43. 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






44. 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






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






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






47. A monthly fee paid by the insured for specific medical insurance coverage






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






49. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






50. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member