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






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






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






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






5. 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.






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






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






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






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






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






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






12. A patient claim is eligible for medicare and medicaid






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






14. 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)






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






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






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






18. 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






19. 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






20. 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






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






22. 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






23. 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






24. 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






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






26. 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.






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

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






29. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






30. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






31. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






33. 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






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






35. 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






36. 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






37. 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.






38. 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






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






40. 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






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






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






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






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






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






46. 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.






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






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






49. Unauthorized release of information






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