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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. A patient claim is eligible for medicare and medicaid






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






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






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






6. 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.






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






8. 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






9. 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






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






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






12. 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)






13. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






14. 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






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






16. 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






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






18. 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.






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






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






21. 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






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






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






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






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






26. 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






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






28. 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






29. 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






30. 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






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






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. 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.






34. 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.






35. 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






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






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






38. 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.






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

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40. Unauthorized release of information






41. 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






42. 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






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






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






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






46. 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






47. 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






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






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






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