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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 monthly fee paid by the insured for specific medical insurance coverage






2. 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






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






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






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






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






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






8. A patient claim is eligible for medicare and medicaid






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






10. 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






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






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






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






14. 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






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






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






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






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






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






20. 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.






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






22. Unauthorized release of information






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






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






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






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






27. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






29. 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.






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






31. American Medical Association






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






33. 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






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






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






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






37. 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






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






39. Medical services provided on an outpatient basis






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






41. Individually identifiable health information






42. 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






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






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






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






46. 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.






47. Billing for services not performed






48. 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






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






50. 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






Can you answer 50 questions in 15 minutes?



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