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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. 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






3. Health Information Portability and Accountability Act






4. 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






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






6. 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






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






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






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






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






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






12. Health Information Portability and Accountability Act






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






14. 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






15. 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.






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






17. A rule - condition - or requirement






18. 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






19. 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






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






21. 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






22. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






23. A nonprofit integrated delivery system






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






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






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






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






28. 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.






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






31. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






32. Unauthorized release of information






33. 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






34. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






35. 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.






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






37. A rule - condition - or requirement






38. 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






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






40. Billing for services not performed






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






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






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






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






45. Medical staff member who is legally responsible for the care and treatment given to a patient.






46. 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






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






48. 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






49. 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.






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






Can you answer 50 questions in 15 minutes?



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