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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. 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






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






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






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






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






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






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






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






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






10. 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.






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






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

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13. 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






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






15. 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






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






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






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. 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)






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






22. A nonprofit integrated delivery system






23. 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.






24. 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






25. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






26. 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






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






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






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






30. 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






31. A nonprofit integrated delivery system






32. What the insurance company will consider paying for as defined in the contract.






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






34. 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






35. 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






36. 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






37. Health Information Portability and Accountability Act






38. The period of time that payment for Medicare inpatient hospital benefits are available






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






40. 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.






41. 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.






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






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






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






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






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






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






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

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






50. 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







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