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






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






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






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






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






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






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. 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






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






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






12. 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.






13. 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






14. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






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






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






18. Standards of conduct generally accepted as a moral guide for behavior.






19. 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






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






21. Medical services provided on an outpatient basis






22. 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






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






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






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






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






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






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






29. 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.






30. A patient claim is eligible for medicare and medicaid






31. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






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






33. 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)






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






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






36. 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






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






38. 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






39. 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)






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

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41. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






42. 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






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






44. 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






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






46. 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






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






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






49. 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.






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







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