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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 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.






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






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






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






5. 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.






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






7. 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.






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






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






10. 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






11. 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






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






13. Unauthorized release of information






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






15. 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






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






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






18. 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






19. 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






20. Individually identifiable health information






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






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






23. 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






24. 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






25. 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






26. 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)






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






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






30. 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






31. 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






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






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






34. 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






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






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






37. 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.






38. 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






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






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






41. Billing for services not performed






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






43. 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






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. 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.






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






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






48. 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






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






50. 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






Can you answer 50 questions in 15 minutes?



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