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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. 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.






2. 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






3. 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






4. 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.






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






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






7. 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






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






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






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






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






12. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






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






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






15. 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






16. Health Information Portability and Accountability Act






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






18. 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)






19. 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






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






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






22. 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.






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






24. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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






26. 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






27. A rule - condition - or requirement






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






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






30. 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






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






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






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






34. A nonprofit integrated delivery system






35. 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.






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. 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






38. 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






39. 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






40. 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






41. 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






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






43. 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.






44. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






45. Unauthorized release of information






46. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






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






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






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






50. The condition of being secluded from the presence or view of others.







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