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






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






3. A patient claim is eligible for medicare and medicaid






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






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






6. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






7. Medical services provided on an outpatient basis






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






9. A nonprofit integrated delivery system






10. American Medical Association






11. 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.






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






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






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






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






16. 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






17. Individually identifiable health information






18. 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.






19. 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






20. American Medical Association






21. Health Information Portability and Accountability Act






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






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






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






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






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






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






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






29. 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






30. Medical services provided on an outpatient basis






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






32. 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.






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






34. 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






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






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






37. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






38. 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






39. 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.






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






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






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






43. 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






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






45. 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






46. 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.






47. 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






48. 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






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






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







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