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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. 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






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






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






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






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






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






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






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






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

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






13. 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






14. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






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






16. 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






17. 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






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






19. Billing for services not performed






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






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






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






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






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






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






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






27. 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






28. Medical services provided on an outpatient basis






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. 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






31. A nonprofit integrated delivery system






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






33. Billing for services not performed






34. 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.






35. 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






36. 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.






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






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






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






40. 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






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






42. 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.






43. 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.






44. 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






45. 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






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






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






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






49. 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.






50. 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







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