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






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






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






5. 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.






6. 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






7. Billing for services not performed






8. 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.






9. 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.






10. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






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






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






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






15. Individually identifiable health information






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






17. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






19. 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.






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






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






22. 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






23. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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






25. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






27. 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






28. 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






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






30. 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






31. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






33. 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






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






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






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






37. 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






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






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






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






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






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






43. 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






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






45. 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






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






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






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






49. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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