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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. 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






2. Unauthorized release of information






3. 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.






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






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






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






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






8. 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






9. 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)






10. 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






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






12. 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






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






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






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






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






18. Individually identifiable health information






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






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






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






23. 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.






24. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






26. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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






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






29. 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






30. American Medical Association






31. 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






32. 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






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






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






35. 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






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






37. 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






38. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






39. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






42. 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






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






44. 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.






45. 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






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






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






48. Health Information Portability and Accountability Act






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






50. 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