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






2. 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






3. 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.






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






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






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






7. 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






8. 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






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






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






11. 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






12. 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






13. Unauthorized release of information






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






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






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






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






20. 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






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






22. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






23. A patient claim is eligible for medicare and medicaid






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






25. 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






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






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






28. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






29. 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






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






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






32. 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.






33. 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






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






35. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






36. 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






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






38. 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






39. 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.






40. 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.






41. 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






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






43. A rule - condition - or requirement






44. 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






45. An organization of provider sites with a contracted relationship that offer services






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

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






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. 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






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







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Can you answer 50 questions in 15 minutes?


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