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






2. A nonprofit integrated delivery system






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






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






5. Customs - rules of conduct - courtesy - and manners of the medical profession






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






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






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






9. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






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






12. 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






13. 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.






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






15. Health Information Portability and Accountability Act






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






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

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






19. Individually identifiable health information






20. Medical services provided on an outpatient basis






21. 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






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






23. 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






24. 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






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






26. A rule - condition - or requirement






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






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






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






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






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






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






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

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






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






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






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






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






39. 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.






40. 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






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






42. 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.






43. 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






44. 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.






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






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






47. 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.






48. 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






49. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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






Can you answer 50 questions in 15 minutes?



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