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






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






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. 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






5. 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






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. 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.






8. Health Information Portability and Accountability Act






9. 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.






10. 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






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






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






13. 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.






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






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






16. 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






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






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






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






20. 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






21. 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






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






23. 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






24. 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






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






26. 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)






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






28. 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.






29. 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.






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






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. 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






33. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






34. 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.






35. 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






36. 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.






37. 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






38. 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






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






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






41. American Medical Association






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






43. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






44. 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.






45. 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






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






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






48. 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






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






50. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage