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






2. 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.






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






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






5. 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






6. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






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






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






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






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






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






12. 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






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






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






15. Unauthorized release of information






16. 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






17. 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






18. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






19. 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






20. 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






21. Health Information Portability and Accountability Act






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






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






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






25. 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.






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






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






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






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






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






31. 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






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






33. 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.






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






35. 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






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






37. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






39. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






40. Medical staff member who is legally responsible for the care and treatment given to a patient.






41. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






42. Medical services provided on an outpatient basis






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






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






45. Billing for services not performed






46. 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






47. 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.






48. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






49. 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






50. 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