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






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






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






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






5. 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






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






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






8. 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






9. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






10. 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






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






12. 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






13. 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.






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






15. 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






16. 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






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






18. 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






19. 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.






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






21. A patient claim is eligible for medicare and medicaid






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






23. A rule - condition - or requirement






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






25. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






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






27. 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






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






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. Unauthorized release of information






31. 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






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






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






34. Individually identifiable health information






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






36. 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






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






38. 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






39. 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






40. 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.






41. Medical services provided on an outpatient basis






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






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






44. 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






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






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






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






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






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






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






Can you answer 50 questions in 15 minutes?



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