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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. American Medical Association






2. Individually identifiable health information






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






4. 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






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. Individually identifiable health information






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






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






9. 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.






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






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






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






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






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






15. The maximum amount a plan pays for a covered service






16. Medical services provided on an outpatient basis






17. A review of the need for inpatient hospital care - completed before the actual admission






18. 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)






19. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






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






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






22. 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.






23. 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






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






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






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






27. 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






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






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






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






31. Unauthorized release of information






32. 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






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






34. 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.






35. 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






36. 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






37. 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






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






39. 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.






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






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






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






43. 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






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






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






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






47. Unauthorized release of information






48. 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.






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






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