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






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






3. 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






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






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






6. 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






7. 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






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






9. 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






10. The amount of actual money available to the medical practice






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






12. 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






13. 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.






14. 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






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






16. 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






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

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






19. Unauthorized release of information






20. 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






21. 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.






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






23. 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






24. 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






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






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






27. 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.






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






29. 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






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






31. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






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






33. Individually identifiable health information






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






35. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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






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






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






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






40. 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






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






42. 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






43. Health Information Portability and Accountability Act






44. 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






45. 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






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






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






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






49. A rule - condition - or requirement






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