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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. 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.






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






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






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

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






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






7. 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.






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






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






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






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






12. 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.






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






14. 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.






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






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






17. 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






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






19. 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






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






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






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






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






24. Unauthorized release of information






25. 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






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






27. 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






28. 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






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






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






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






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






33. 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






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






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






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






37. 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






38. 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






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






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






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






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






43. 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






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






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






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






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






48. 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






49. 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.






50. 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.







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