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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. 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






2. 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)






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






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






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






6. Medical services provided on an outpatient basis






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






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






9. 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






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






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






12. 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






13. 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






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






15. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






17. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






18. 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






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






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






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






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






23. A rule - condition - or requirement






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






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






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






27. Unauthorized release of information






28. 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






29. 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






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






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






32. 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






33. A patient claim is eligible for medicare and medicaid






34. 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






35. 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.






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






37. 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.






38. American Medical Association






39. 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






40. A provision that apples when a person is covered under more than one group medical program






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






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






43. 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.






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






45. Billing for services not performed






46. A rule - condition - or requirement






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






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






49. 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.






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