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






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






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






4. Standards of conduct generally accepted as a moral guide for behavior.






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






6. 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






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






8. 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






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






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






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






12. A nonprofit integrated delivery system






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






14. 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






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






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






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






19. 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.






20. 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






21. 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.






22. 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






23. 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






24. Health Information Portability and Accountability Act






25. Standards of conduct generally accepted as a moral guide for behavior.






26. 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.






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






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






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






30. 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






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






32. 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






33. 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






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






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






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






37. 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)






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






39. 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






40. Unauthorized release of information






41. 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






42. 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






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






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






45. 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.






46. 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






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






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






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






50. 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