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






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






3. 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)






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






5. 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






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






7. 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






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






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






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






11. 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






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






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






14. 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






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






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






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






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

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20. 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






21. 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.






22. 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






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






24. 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.






25. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






26. 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






27. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






28. 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






29. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






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






32. 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.






33. 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.






34. A rule - condition - or requirement






35. 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






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






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






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






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






40. American Medical Association






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






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






43. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






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






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






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






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






48. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






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