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






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






4. 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






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






6. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






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






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






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






10. 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






11. 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.






12. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






13. 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






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






15. Customs - rules of conduct - courtesy - and manners of the medical profession






16. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






17. 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






18. 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






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






20. 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






21. 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






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






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






24. 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






25. 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






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






27. 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






28. 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






29. The period of time that payment for Medicare inpatient hospital benefits are available






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






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






32. A nonprofit integrated delivery system






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






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






35. The period of time that payment for Medicare inpatient hospital benefits are available






36. Individually identifiable health information






37. 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.






38. 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






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






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






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






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






43. 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






44. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






46. 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






47. 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






48. 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






49. A nonprofit integrated delivery system






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