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






2. 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






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






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






5. Health Information Portability and Accountability Act






6. 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)






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






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






9. Health Information Portability and Accountability Act






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






11. Unauthorized release of information






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






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






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






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






16. 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.






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






18. 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






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






20. 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






21. A rule - condition - or requirement






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






23. 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






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






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






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






27. American Medical Association






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






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






30. 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






31. Individually identifiable health information






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






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






34. 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






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






36. 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.






37. 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






38. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






39. 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






40. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






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






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






43. 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)






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






45. 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






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






47. 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.






48. 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






49. A willful act by an employee of taking possession of an employer's money






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