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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. 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






2. Health Information Portability and Accountability Act






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






4. A nonprofit integrated delivery system






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






6. 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.






7. 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






8. 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






9. Individually identifiable health information






10. 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.






11. 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






12. 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.






13. 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






14. 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






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






16. 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






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






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






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






20. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






21. Medical services provided on an outpatient basis






22. 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






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






24. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






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






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






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






31. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






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






33. 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.






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






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






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






37. Individually identifiable health information






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






39. Unauthorized release of information






40. 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






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






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






43. 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






44. Medical services provided on an outpatient basis






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






46. Is a provider who sends the patients for testing or treatment






47. 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






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






49. 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.






50. Programs designed to reduce unnecessary medical services - both inpatient and outpatient