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






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

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






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






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






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






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






8. 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






9. 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.






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






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






12. Someone who is eligible for or receiving benefits under an insurance policy or plan






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






14. 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






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






16. 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.






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






18. 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






19. 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)






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






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






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






23. 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






24. 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.






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






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






27. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






29. 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)






30. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






31. 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.






32. Integrating benefits payable under more than one health insurance.






33. 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






34. 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






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






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






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






38. Unauthorized release of information






39. Individually identifiable health information






40. 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






41. American Medical Association






42. 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






43. 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.






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






45. 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






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






48. 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






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






50. 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







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Can you answer 50 questions in 15 minutes?


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