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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 structure for classifying outpatient services and procedures for purpose of payment






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






3. 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






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






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






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






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






8. 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






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






10. 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.






11. 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.






12. 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






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






14. 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






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






16. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






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






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






20. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






21. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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






23. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






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






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






27. Health Information Portability and Accountability Act






28. 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.






29. Billing for services not performed






30. 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






31. 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.






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






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






34. 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






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






36. 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






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






38. 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






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






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






41. 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.






42. 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






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






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






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






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






47. 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






48. 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






49. 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






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






Can you answer 50 questions in 15 minutes?



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