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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. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






3. Individually identifiable health information






4. 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






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






6. 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)






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






8. 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






9. 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.






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






11. 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






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






13. A patient claim is eligible for medicare and medicaid






14. A clinic that is owned by the HMO and the physicians are employees of the HMO






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






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






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






18. A clinic that is owned by the HMO and the physicians are employees of the HMO






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






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






21. 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






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






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






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






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






26. 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






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






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






29. Medical services provided on an outpatient basis






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






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






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






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






34. 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)






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






36. 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






37. An organization of provider sites with a contracted relationship that offer services






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






39. Is the provider who renders a service to a patient






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






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






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






43. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






44. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






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






46. 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






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






48. A nonprofit integrated delivery system






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






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