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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. Individually identifiable health information






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






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






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 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.






6. 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






7. 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.






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






9. 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






10. 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






11. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






12. 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






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






14. 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.






15. 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






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






17. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






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






19. 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






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






21. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






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






24. A review of the need for inpatient hospital care - completed before the actual admission






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






26. 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






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






28. American Medical Association






29. Unauthorized release of information






30. 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






31. 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






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






33. Individually identifiable health information






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






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






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






37. 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






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






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






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






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






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






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






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






45. 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






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






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






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






49. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






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