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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. 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






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






3. 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.






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






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






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






7. 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






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






9. 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.






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






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

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






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






14. 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






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






16. Billing for services not performed






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






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






19. 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






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






21. 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






22. 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.






23. Health Information Portability and Accountability Act






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






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






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






27. 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.






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






29. 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






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






31. 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






32. A nonprofit integrated delivery system






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






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






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






36. 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






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






38. 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.






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






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






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






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






43. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






44. 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.






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






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






47. 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






48. A patient claim is eligible for medicare and medicaid






49. 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






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