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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. Medical services provided on an outpatient basis






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






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






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






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






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






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






8. Individually identifiable health information






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






10. 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






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






12. 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






13. 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






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






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






16. 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.






17. 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






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






19. American Medical Association






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






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






22. A rule - condition - or requirement






23. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






24. A nonprofit integrated delivery system






25. 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.






26. 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






27. 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.






28. 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






29. 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.






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






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






32. 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.






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






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






35. 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






36. Billing for services not performed






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






38. Unauthorized release of information






39. 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






40. 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






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






42. 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






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






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






45. 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.






46. 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






47. 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






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






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






50. 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