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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 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






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






3. 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.






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






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






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






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






8. 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.






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






10. 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






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






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






13. Individually identifiable health information






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






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






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






17. 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






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






19. 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






20. 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






21. 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






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






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






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






25. Medical services provided on an outpatient basis






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






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






28. 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.






29. A patient claim is eligible for medicare and medicaid






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






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






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






33. A nonprofit integrated delivery system






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






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






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






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






38. 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






39. 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






40. 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






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






42. Unauthorized release of information






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






44. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






47. 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






48. 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






49. 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






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