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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 rule - condition - or requirement






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






3. Medical services provided on an outpatient basis






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






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






6. 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.






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






8. 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






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






10. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






11. An organization of provider sites with a contracted relationship that offer services






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






13. 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






14. 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.






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






16. Individually identifiable health information






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






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






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






20. 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






21. 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






22. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






23. Unauthorized release of information






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






25. 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.






26. 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.






27. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






28. 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






29. 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.






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






31. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






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






34. 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






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






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






37. 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






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






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






40. 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






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






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






43. 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






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






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






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






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






48. 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






49. Health Information Portability and Accountability Act






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