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






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






3. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






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






5. 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






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






7. 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






8. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






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






11. 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






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






13. A nonprofit integrated delivery system






14. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






15. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






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






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






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






20. 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






21. Billing for services not performed






22. 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.






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






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






25. 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.






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






27. 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






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






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






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






31. Billing for services not performed






32. Is a provider who sends the patients for testing or treatment






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






34. 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






35. 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






36. 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






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






38. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






39. 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.






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






41. 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






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






43. 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






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






45. 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






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






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






48. 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.






49. 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






50. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations







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