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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. Health Information Portability and Accountability Act






2. 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.






3. 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






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






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






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






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






8. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






9. 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






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






11. Verbal or written agreement that gives approval to some action - situation - or statement.






12. 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






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






14. 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.






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






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






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






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






19. A nonprofit integrated delivery system






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

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

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






23. 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






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






25. Medical services provided on an outpatient basis






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






27. 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)






28. 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.






29. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






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






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






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






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






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






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






37. 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






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






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






40. 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






41. 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






42. 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.






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






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






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






46. Unauthorized release of information






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






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






49. A nonprofit integrated delivery system






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






Can you answer 50 questions in 15 minutes?



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