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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. 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






2. 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






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






4. 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)






5. 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






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






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






8. 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






9. 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






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






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






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






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






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






15. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






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






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






19. American Medical Association






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






21. 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






22. 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






23. 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






24. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






25. Health Information Portability and Accountability Act






26. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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






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






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






30. 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






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






32. Someone who is eligible for or receiving benefits under an insurance policy or plan






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






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






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






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 nonprofit integrated delivery system






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






39. 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






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






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






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






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






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






45. 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






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






47. Billing for services not performed






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






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






50. 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.







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