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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 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.






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






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






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






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






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






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






8. 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.






9. 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






10. 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)






11. 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






12. 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






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






14. An organization of provider sites with a contracted relationship that offer services






15. A provision that apples when a person is covered under more than one group medical program






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






18. 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






19. 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






20. 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






21. Individually identifiable health information






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






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






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






25. 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






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






27. A rule - condition - or requirement






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






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






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






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






32. 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.






33. 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






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






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






36. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






38. 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






39. Customs - rules of conduct - courtesy - and manners of the medical profession






40. 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






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






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






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






44. A nonprofit integrated delivery system






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






46. 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.






47. A patient claim is eligible for medicare and medicaid






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






49. 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.






50. Customs - rules of conduct - courtesy - and manners of the medical profession







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