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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. Health Information Portability and Accountability Act






2. American Medical Association






3. Verbal or written agreement that gives approval to some action - situation - or statement.






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






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






6. 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






7. A patient claim is eligible for medicare and medicaid






8. Unauthorized release of information






9. 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.






10. 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






11. 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






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






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






14. Billing for services not performed






15. 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






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






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






18. 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






19. A patient claim is eligible for medicare and medicaid






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. 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






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






24. Health Information Portability and Accountability Act






25. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






26. 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.






27. 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






28. 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






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






30. 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






31. 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






32. Verbal or written agreement that gives approval to some action - situation - or statement.






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






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






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






36. 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






37. A rule - condition - or requirement






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






40. 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






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






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






43. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






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






46. 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






47. Billing for services not performed






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






49. 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.






50. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner







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