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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 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






2. 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.






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






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






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






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






8. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






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






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






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






12. 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






13. 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






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

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15. 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






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






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






18. 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.






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






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






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






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






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






24. 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.






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






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






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






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






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






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






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






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






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






35. 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






36. 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






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






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






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






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






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






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






44. American Medical Association






45. 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.






46. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






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






48. 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






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






50. 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






Can you answer 50 questions in 15 minutes?



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