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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. 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.






2. 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.






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






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






5. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






6. A provision that apples when a person is covered under more than one group medical program






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






8. 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.






9. 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






10. 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






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






12. 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.






13. A rule - condition - or requirement






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






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






16. 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.






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






18. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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. 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






21. 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.






22. A nonprofit integrated delivery system






23. 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






24. 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






25. 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






26. 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






27. A nonprofit integrated delivery system






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






29. 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






30. 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






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






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






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






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






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






36. 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






37. Billing for services not performed






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






39. 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






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






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






42. American Medical Association






43. 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






44. 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






45. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






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






47. 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.






48. 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






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






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