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






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






3. 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.






4. 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






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






6. Medical services provided on an outpatient basis






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






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






9. 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






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






11. 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






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






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






14. 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






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






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






17. 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






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






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






20. 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






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






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






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






24. 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.






25. 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






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






27. 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






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






29. 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






30. A rule - condition - or requirement






31. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






32. 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






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






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






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






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






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






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






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






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






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






42. Medicare's method of paying acute care hospitals for inpatient care






43. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






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






46. American Medical Association






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






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






49. A nonprofit integrated delivery system






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