Test your basic knowledge |

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






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






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






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






5. An intentional misrepresentation of the facts to deceive or mislead another.






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






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






8. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






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






10. 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






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






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






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






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






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






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






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






18. 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






19. 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






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






21. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






22. 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.






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






24. 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.






25. A clinic that is owned by the HMO and the physicians are employees of the HMO






26. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






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. 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






31. 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






32. 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






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






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. 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.






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






37. 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






38. An intentional misrepresentation of the facts to deceive or mislead another.






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






40. 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






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






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






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






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






45. Billing for services not performed






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






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






48. 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






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






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