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

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2. 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.






3. 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






4. 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)






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






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






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






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






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






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






11. Individually identifiable health information






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






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






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






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. A list of the amount to be paid by an insurance company for each procedure service






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






18. 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






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






20. Billing for services not performed






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






22. American Medical Association






23. 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






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






25. 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






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






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






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






29. 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.






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






31. 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.






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






33. 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.






34. 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.






35. 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.






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






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






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






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






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






41. 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.






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






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






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






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






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






47. 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






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

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






50. Health Information Portability and Accountability Act







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