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






2. Health Information Portability and Accountability Act






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






4. 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.






5. 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.






6. 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






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






8. 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.






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






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






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






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






13. 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






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






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






16. 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






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






18. 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






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






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






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






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






23. 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






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






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






26. A clinic that is owned by the HMO and the physicians are employees of the HMO






27. 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






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






29. Individually identifiable health information






30. A patient claim is eligible for medicare and medicaid






31. 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






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






33. A patient claim is eligible for medicare and medicaid






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






35. Health Information Portability and Accountability Act






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






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






38. 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.






39. 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.






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






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






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






43. 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






44. Individually identifiable health information






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






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






47. 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






48. 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






49. 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






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






Can you answer 50 questions in 15 minutes?



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