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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. 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.






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






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






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






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






6. Medical services provided on an outpatient basis






7. 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






8. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






9. 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






10. 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






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






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






13. The period of time that payment for Medicare inpatient hospital benefits are available






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






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






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






18. 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.






19. 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






20. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






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






23. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






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






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






28. Billing for services not performed






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






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






31. Unauthorized release of information






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






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






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

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35. 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






36. Billing for services not performed






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






38. 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






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






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






41. 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






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






43. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






44. Unauthorized release of information






45. 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






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






47. 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






48. 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






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







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