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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists






2. 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.






3. 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






4. 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






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






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






7. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






8. 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






9. 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






10. 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.






11. Health Information Portability and Accountability Act






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






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






14. 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






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






16. Health Information Portability and Accountability Act






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






18. 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






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






20. 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






21. 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






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






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






24. Billing for services not performed






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






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






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






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






29. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






31. 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






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






33. 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






34. 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






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






36. 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






37. 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






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






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






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






41. Billing for services not performed






42. 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






43. 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.






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






45. 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






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






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






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






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






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