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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 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.






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






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






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






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






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






7. A nonprofit integrated delivery system






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

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9. 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






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






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. 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.






13. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






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






16. 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






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






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






19. A rule - condition - or requirement






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






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






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






23. 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






24. 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






25. 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






26. 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






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






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






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






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






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






32. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






33. Health Information Portability and Accountability Act






34. 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






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






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






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






38. 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






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






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






41. 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






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






43. 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






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






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






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






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






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






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






50. A provision that apples when a person is covered under more than one group medical program