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






2. 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






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






4. 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.






5. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






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






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






10. 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






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






12. 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






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






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






15. 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.






16. 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.






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






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






19. A provision that apples when a person is covered under more than one group medical program






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






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






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






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






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






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






26. 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






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


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






29. 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






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






31. 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






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






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






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






35. Individually identifiable health information






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






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






39. Billing for services not performed






40. Health Information Portability and Accountability Act






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






42. 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






43. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






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






45. 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






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






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






48. A patient claim is eligible for medicare and medicaid






49. 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.






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