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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. 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






2. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






3. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






4. 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






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






6. The dates of healthcare services were provided to the beneficiary






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






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






9. Medical services provided on an outpatient basis






10. 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






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






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






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






14. 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






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






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






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






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






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






20. 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






21. 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






22. 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.






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






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






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






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






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






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






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






30. 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.






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






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






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






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






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






36. American Medical Association






37. Individually identifiable health information






38. 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






39. Billing for services not performed






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






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






42. 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






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






44. A patient claim is eligible for medicare and medicaid






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






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






47. Individually identifiable health information






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






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






50. 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.






Can you answer 50 questions in 15 minutes?



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