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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 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






2. A rule - condition - or requirement






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






4. 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






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






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






7. 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






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






9. 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






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






11. Unauthorized release of information






12. 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






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






14. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






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






16. 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






17. 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






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






19. 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






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






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






22. 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






23. 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.






24. 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.






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






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






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






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






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






31. Medical services provided on an outpatient basis






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

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






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






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






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






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






38. 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






39. 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.






40. 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






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






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






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






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






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






46. The maximum amount a plan pays for a covered service






47. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






48. 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






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






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






Can you answer 50 questions in 15 minutes?



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