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






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






3. American Medical Association






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






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






6. Medical services provided on an outpatient basis






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






8. 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






9. 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.






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






11. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






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






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






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






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






16. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






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






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






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






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

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22. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






24. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






26. A nonprofit integrated delivery system






27. 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






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






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






31. 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






32. 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.






33. 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






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






35. The condition of being secluded from the presence or view of others.






36. 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.






37. 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.






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






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






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






41. 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.






42. 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.






43. The condition of being secluded from the presence or view of others.






44. 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






45. 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






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






47. 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






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






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






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







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