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






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






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






4. A nonprofit integrated delivery system






5. 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)






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






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






8. 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.






9. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






10. 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






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






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






13. Billing for services not performed






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






15. A privileged communication that may be disclosed only with the patient's permission.






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






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






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






19. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






21. 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.






22. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






23. 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






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

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25. 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






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






27. Individually identifiable health information






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






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






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






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






32. Medical services provided on an outpatient basis






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






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






35. 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.






36. 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






37. 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)






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






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






40. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






43. A nonprofit integrated delivery system






44. 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






45. The condition of being secluded from the presence or view of others.






46. 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






47. A rule - condition - or requirement






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






49. 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






50. 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.