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






2. 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






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






4. 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






5. 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






6. 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






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






8. Medical services provided on an outpatient basis






9. A structure for classifying outpatient services and procedures for purpose of payment






10. 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.






11. Individually identifiable health information






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






13. 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






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






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






16. 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






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






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






19. 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






20. 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.






21. Billing for services not performed






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






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






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






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






26. 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






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






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






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






30. 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






31. 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.






32. 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






33. 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






34. 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.






35. 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






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






37. 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






38. A nonprofit integrated delivery system






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






40. 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.






41. 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






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






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






44. 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






45. 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.






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






47. 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






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






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






50. 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