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






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






3. 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






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






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






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






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






8. 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






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






10. 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






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






12. Medical services provided on an outpatient basis






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






14. Billing for services not performed






15. 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






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






17. 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






18. 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






19. 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






20. 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






21. 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.






22. 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






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






24. 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






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






26. 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.






27. 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.






28. A patient claim is eligible for medicare and medicaid






29. 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






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






31. 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






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






33. 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






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






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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


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






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






38. 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






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






40. 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.






41. 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.






42. 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






43. 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






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






45. 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






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






47. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






48. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






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






50. 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.