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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. The maximum amount a plan pays for a covered service






2. 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.






3. Medical services provided on an outpatient basis






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






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






6. 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.






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






8. 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






9. 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.






10. 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






11. 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






12. 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






13. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






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






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






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






18. 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






19. 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






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






21. Individually identifiable health information






22. Medical services provided on an outpatient basis






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






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






25. 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






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






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






29. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






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






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. 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)






34. 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






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






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






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






38. 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






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






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






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






42. 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






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






44. 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.






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






46. 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






47. A nonprofit integrated delivery system






48. 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.






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






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