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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 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.






2. The maximum amount a plan pays for a covered service






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






4. 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)






5. 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






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






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






8. 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






9. Health Information Portability and Accountability Act






10. A patient claim is eligible for medicare and medicaid






11. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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






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






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






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






16. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






17. Billing for services not performed






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






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






21. Billing for services not performed






22. 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






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






24. The maximum amount a plan pays for a covered service






25. A nonprofit integrated delivery system






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






27. 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






28. 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.






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






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






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






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






33. A rule - condition - or requirement






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






35. Health Information Portability and Accountability Act






36. 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






37. 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






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






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






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






41. 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






42. 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






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






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






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. 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






47. A patient claim is eligible for medicare and medicaid






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






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

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