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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. 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






2. 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






3. 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






4. 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.






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






6. 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






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






8. 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






9. 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






10. Individually identifiable health information






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






12. 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






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






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


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






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






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






18. 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






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






20. 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






21. 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






22. What the insurance company will consider paying for as defined in the contract.






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






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






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






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






27. Unauthorized release of information






28. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






30. 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.






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






32. 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






33. 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






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






35. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






36. 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






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






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






39. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






40. 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






41. 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






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






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






44. Unauthorized release of information






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






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






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






48. Medical services provided on an outpatient basis






49. 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






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