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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 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.






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






3. American Medical Association






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






5. Unauthorized release of information






6. 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.






7. 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






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






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






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






11. 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






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






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






14. 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






15. A nonprofit integrated delivery system






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






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






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






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






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






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






22. 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






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






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






25. Unauthorized release of information






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






27. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






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






30. 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.






31. 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






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. 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






34. 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






35. 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






36. 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)






37. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






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






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






41. 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






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






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






44. 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.






45. 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






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






47. 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






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






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






50. Billing for services not performed