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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. 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. 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






4. 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






5. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






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






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






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






10. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






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






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






14. 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






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






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






17. 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






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






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






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






21. Billing for services not performed






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






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






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






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






26. 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






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






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






29. 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.






30. 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






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






32. Individually identifiable health information






33. 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






34. 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.






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






36. 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






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






38. 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






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






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. 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






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






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






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






46. 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






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






48. A willful act by an employee of taking possession of an employer's money






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






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







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