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 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






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






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






4. 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






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






6. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






7. 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






8. 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






9. 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






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






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






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






13. 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






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






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 structure for classifying outpatient services and procedures for purpose of payment






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






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






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






20. 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






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. 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






23. 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.






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






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






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






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






28. 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)






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






30. 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






31. A rule - condition - or requirement






32. 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






33. 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






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






35. Individually identifiable health information






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






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






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






39. American Medical Association






40. A patient claim is eligible for medicare and medicaid






41. 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






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






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






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






45. 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






46. Individually identifiable health information






47. 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






48. 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






49. 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






50. 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