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






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






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






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






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






7. 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






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






9. 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






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






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






12. 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.






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






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






15. A patient claim is eligible for medicare and medicaid






16. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






17. 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






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






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






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






22. 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.






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






24. 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.






25. 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






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






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






28. 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






29. 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






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






31. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






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






34. A health insurance enrollee chooses to see an out of network provider without authorization






35. 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






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






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






38. Unauthorized release of information






39. A rule - condition - or requirement






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






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






42. American Medical Association






43. A nonprofit integrated delivery system






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






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






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






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






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






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






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.