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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 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






2. 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.






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






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






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






6. American Medical Association






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






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






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






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






11. 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






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






13. 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






14. A patient claim is eligible for medicare and medicaid






15. 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.






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






17. 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






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






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






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






21. A nonprofit integrated delivery system






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






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






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






25. 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






26. 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






27. 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






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






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






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






31. 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.






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






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

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34. 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.






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






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






37. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






38. 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






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






40. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






41. 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






42. A nonprofit integrated delivery system






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






44. 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






45. 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






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






47. 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






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






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






50. 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






Can you answer 50 questions in 15 minutes?



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