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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. 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






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






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






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






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. 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.






9. 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)






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






11. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






12. 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






13. American Medical Association






14. 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






15. 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






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






17. Unauthorized release of information






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






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






20. 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.






21. 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.






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






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






24. 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






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






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






27. 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






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






29. Integrating benefits payable under more than one health insurance.






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






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






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






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






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






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






36. 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.






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






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






39. 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






40. American Medical Association






41. 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






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






43. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






44. 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






45. 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.






46. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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






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






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






50. 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