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






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






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






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






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






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






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






8. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






9. Health Information Portability and Accountability Act






10. Individually identifiable health information






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






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






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






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






15. 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






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






17. 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






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






19. Medicare's method of paying acute care hospitals for inpatient care






20. 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.






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






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






24. 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.






25. 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






26. A list of the amount to be paid by an insurance company for each procedure service






27. A nonprofit integrated delivery system






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






29. 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






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






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






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






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






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






35. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






38. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






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






41. 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






42. Billing for services not performed






43. American Medical Association






44. 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






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






46. The condition of being secluded from the presence or view of others.






47. 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






48. 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






49. 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






50. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment