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






2. A patient claim is eligible for medicare and medicaid






3. 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.






4. 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.






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






6. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






8. 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






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






10. 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






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






12. 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.






13. 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.






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






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






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






17. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






18. A rule - condition - or requirement






19. 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






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






21. 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






22. 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






23. 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.






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






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






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






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






28. 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






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






30. 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






31. 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






32. 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






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






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






35. American Medical Association






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






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






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






39. 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






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






41. 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






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






43. 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






44. 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






45. 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






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






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






48. 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






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






50. 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







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