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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. 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.






2. 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.






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






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






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






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






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






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






9. 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






10. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






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






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






14. 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.






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






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






17. 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






18. 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






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






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






21. 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






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






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






24. A nonprofit integrated delivery system






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

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26. 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






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






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






29. 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






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






31. 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.






32. 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






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






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






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






36. Health Information Portability and Accountability Act






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






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






39. 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






40. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






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






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






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






45. 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






46. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






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






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






50. 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







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