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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. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






3. 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






4. 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






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






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






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 patient claim is eligible for medicare and medicaid






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






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






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






12. 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.






13. 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.






14. 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






15. 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






16. 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.






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






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






19. A nonprofit integrated delivery system






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






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






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






24. Individually identifiable health information






25. 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.






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






27. Medical services provided on an outpatient basis






28. 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.






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






30. 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.






31. A rule - condition - or requirement






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






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






34. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






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






36. 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






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






38. A nonprofit integrated delivery system






39. 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.






40. Individually identifiable health information






41. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






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






43. 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.






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






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






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






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






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






49. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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