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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. 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






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






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






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






5. 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.






6. 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






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






8. 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






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






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






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






12. 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.






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






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






15. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






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






17. 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






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






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






20. 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






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






24. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






26. 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.






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






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






29. 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.






30. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






31. 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.






32. 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






33. 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.






34. 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






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






37. Individually identifiable health information






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






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






40. 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






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






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


43. 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






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






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






47. 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)






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






49. 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






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