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






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






3. A rule - condition - or requirement






4. 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






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

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6. 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






7. 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






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






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






10. An intentional misrepresentation of the facts to deceive or mislead another.






11. 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






12. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






13. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






15. Individually identifiable health information






16. 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






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






18. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






20. 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.






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. 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






23. Medical services provided on an outpatient basis






24. 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






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






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






27. Unauthorized release of information






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






29. 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.






30. American Medical Association






31. Medical services provided on an outpatient basis






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






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






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






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






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






38. 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






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






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






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






42. 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






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






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






45. 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.






46. 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






47. A rule - condition - or requirement






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






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. American Medical Association







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