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






3. Unauthorized release of information






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






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






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






7. 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






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






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






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






12. 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






13. 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






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






15. 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






16. Medical services provided on an outpatient basis






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






18. 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






19. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






20. 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.






21. 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






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






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






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






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






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






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






28. 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






29. 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






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






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. 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






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






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






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






36. Unauthorized release of information






37. 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






38. 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






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






40. 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.






41. A nonprofit integrated delivery system






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






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






44. 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






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






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






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






48. 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






49. 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)






50. 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.