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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 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.






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






3. 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






4. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






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






7. 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






8. 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






9. Individually identifiable health information






10. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






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






12. Unauthorized release of information






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






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






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






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






17. 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.






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






19. 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






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






21. 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.






22. 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






23. Verbal or written agreement that gives approval to some action - situation - or statement.






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






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






26. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






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






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

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






31. 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






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






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






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






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






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






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






38. 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.






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






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






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






42. 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






43. A patient claim is eligible for medicare and medicaid






44. Verbal or written agreement that gives approval to some action - situation - or statement.






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






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






47. Unauthorized release of information






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






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






50. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






Can you answer 50 questions in 15 minutes?



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