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






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






3. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






4. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






5. 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






6. 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






7. Is a provider who sends the patients for testing or treatment






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






9. Billing for services not performed






10. 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






11. 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






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. 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






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






15. 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)






16. A nonprofit integrated delivery system






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






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

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






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






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






22. 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.






23. 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






24. 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






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






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






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






28. American Medical Association






29. A rule - condition - or requirement






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






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






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






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






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






35. 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.






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






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






38. 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






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






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






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






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






43. 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






44. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






45. Medical services provided on an outpatient basis






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






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






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






49. 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)






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







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