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






3. Unauthorized release of information






4. Medical services provided on an outpatient basis






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






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






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






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






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






10. 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






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






12. 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.






13. 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






14. 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.






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






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






17. Individually identifiable health information






18. 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






19. Medicare's method of paying acute care hospitals for inpatient care






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






21. 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






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






23. 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.






24. A privileged communication that may be disclosed only with the patient's permission.






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






26. 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






27. Individually identifiable health information






28. A patient claim is eligible for medicare and medicaid






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






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






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






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






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






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






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






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






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






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






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






40. 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






41. 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.






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






43. 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






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






45. A rule - condition - or requirement






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






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






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






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






50. 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







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