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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. 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.






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






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






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






5. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






6. 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






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






8. A health insurance enrollee chooses to see an out of network provider without authorization






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






10. Individually identifiable health information






11. 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






12. 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






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






14. 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.






15. 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






16. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






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






18. 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.






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






20. Is the provider who renders a service to a patient






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






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






23. 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






24. 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.






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






26. 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






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






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






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






30. American Medical Association






31. 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






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






33. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






34. 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.






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






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

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37. 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






38. Unauthorized release of information






39. 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.






40. Medical services provided on an outpatient basis






41. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






43. 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






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






45. Is the provider who renders a service to a patient






46. Individually identifiable health information






47. Health Information Portability and Accountability Act






48. 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






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






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







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