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






2. 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.






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






4. Billing for services not performed






5. 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.






6. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






8. 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






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






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






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






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






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






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






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






17. 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






18. 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






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






20. 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






21. 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






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






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






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






25. 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)






26. 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






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






28. 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.






29. A nonprofit integrated delivery system






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






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






32. 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






33. A patient claim is eligible for medicare and medicaid






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






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






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






37. 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.






38. 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.






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






40. A rule - condition - or requirement






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






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






43. 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






44. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






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






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






47. 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






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






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






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