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






2. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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






4. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






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






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






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






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






10. Unauthorized release of information






11. 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.






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. 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






14. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






15. 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






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






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






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






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






20. 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






21. 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






22. 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






23. 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






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






25. 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






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






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






28. American Medical Association






29. 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






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






31. 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






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






33. Medical services provided on an outpatient basis






34. 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






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






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






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






38. 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






39. A nonprofit integrated delivery system






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






41. 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.






42. 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






43. 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






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






45. 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






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






47. 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






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






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






50. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).