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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 physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






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






3. Health Information Portability and Accountability Act






4. 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.






5. 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.






6. 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.






7. 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






8. 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






9. 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.






10. 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.






11. A rule - condition - or requirement






12. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






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






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






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. 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






18. Individually identifiable health information






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






20. 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






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






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






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






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






25. The maximum amount a plan pays for a covered service






26. American Medical Association






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






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






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






30. A rule - condition - or requirement






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






32. 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






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






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






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






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






37. 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






38. 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






39. 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






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






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






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






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






44. Billing for services not performed






45. 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






46. A clinic that is owned by the HMO and the physicians are employees of the HMO






47. 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






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






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






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