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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. 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






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






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






4. Medical services provided on an outpatient basis






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






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






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






8. 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






9. 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






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






11. 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






12. 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






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






15. 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.






16. Medical services provided on an outpatient basis






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






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






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






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






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






22. 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






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






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






25. 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.






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






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






28. 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






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






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






31. A nonprofit integrated delivery system






32. Unauthorized release of information






33. 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.






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






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






36. 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






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






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






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






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






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






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






43. 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






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






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






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






48. 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.






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






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