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






3. 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.






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






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






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






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






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






10. 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






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. Is the provider who renders a service to a patient






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






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






15. 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






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






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






19. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






20. American Medical Association






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






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






23. 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






24. 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






25. 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






26. 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.






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. Unauthorized release of information






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






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






31. A rule - condition - or requirement






32. 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






33. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






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






36. 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.






37. 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.






38. 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






39. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






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






41. 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






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






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






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






45. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






46. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






48. 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






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






50. 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