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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. 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






2. 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






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






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






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






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






8. 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)






9. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






10. A list of the amount to be paid by an insurance company for each procedure service






11. 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






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






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






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






15. 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






16. 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.






17. Unauthorized release of information






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






19. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






20. 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






21. Health Information Portability and Accountability Act






22. The maximum amount a plan pays for a covered service






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






24. 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.






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






26. 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






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






28. 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






29. 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






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






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






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






33. 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






34. 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






35. 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






36. 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






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






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






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






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






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






42. A patient claim is eligible for medicare and medicaid






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






44. 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.






45. Billing for services not performed






46. 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.






47. 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






48. The maximum amount a plan pays for a covered service






49. American Medical Association






50. 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