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






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






3. A rule - condition - or requirement






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






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






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






7. Medical services provided on an outpatient basis






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






9. A willful act by an employee of taking possession of an employer's money






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






11. Health Information Portability and Accountability Act






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






13. A nonprofit integrated delivery system






14. 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






15. 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






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






17. 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






18. 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.






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






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






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






22. 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.






23. 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






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






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






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






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






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






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






30. 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






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. 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






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






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






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






36. 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.






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






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






39. 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






40. 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






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






42. 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






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






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






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






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






47. 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






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






49. 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






50. 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.