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


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






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






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






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






6. 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






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






8. 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.






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






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






11. 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






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






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






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






15. 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






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






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






18. 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






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






20. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






21. 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)






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






23. A patient claim is eligible for medicare and medicaid






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






25. 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






26. 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






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






28. A patient claim is eligible for medicare and medicaid






29. 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






30. 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






31. 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






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






33. 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.






34. 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






35. 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






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. 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)






38. A privileged communication that may be disclosed only with the patient's permission.






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






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






41. 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






42. 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






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






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






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






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






47. 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.






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






49. A rule - condition - or requirement






50. 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