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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. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






3. 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)






4. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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






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






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






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






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






10. 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






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






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






13. 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






14. 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






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






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






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






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






19. 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






20. 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






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






22. 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.






23. 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






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






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






26. 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






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






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






29. 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






30. 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






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






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






33. Health Information Portability and Accountability Act






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

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35. 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.






36. A rule - condition - or requirement






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






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






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






40. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






41. 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






42. 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.






43. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






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






45. 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






46. 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






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






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






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






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