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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 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.






2. Medical services provided on an outpatient basis






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






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

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5. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






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






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






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






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






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






13. 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






14. 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






15. 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






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






17. Billing for services not performed






18. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






19. 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






20. 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.






21. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






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






23. 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






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






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






26. 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






27. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






28. 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






29. 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






30. 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






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






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






33. American Medical Association






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






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






36. 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






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






38. 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






39. 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






40. 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






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






42. 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






43. 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






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






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

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






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






48. 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






49. 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






50. 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.