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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. 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






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






3. 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






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






5. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






7. 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






8. American Medical Association






9. 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






10. Unauthorized release of information






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






12. 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.






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






14. American Medical Association






15. 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






16. 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






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






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






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






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






21. 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






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






23. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






24. 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






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






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






27. Health Information Portability and Accountability Act






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






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






30. A health insurance enrollee chooses to see an out of network provider without authorization






31. 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.






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






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






34. 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






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






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






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






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






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






41. 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






42. 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






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






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






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






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. 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.






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






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






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






Can you answer 50 questions in 15 minutes?



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