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






2. 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






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






4. 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.






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






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






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






8. 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






9. 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






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






11. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






12. 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






13. Is the provider who renders a service to a patient






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






15. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






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






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






18. Billing for services not performed






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






20. 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.






21. 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.






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






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






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






25. 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






26. 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






27. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






28. 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






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






30. 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






31. Is the provider who renders a service to a patient






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

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






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. 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.






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






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






38. 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.






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






40. 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






41. 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






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






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






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






45. Individually identifiable health information






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






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






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






49. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






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