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. Unauthorized release of information






2. 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.






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






4. 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






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






6. The dates of healthcare services were provided to the beneficiary






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






8. A nonprofit integrated delivery system






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






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






11. Health Information Portability and Accountability Act






12. 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






13. 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






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






15. 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






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






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






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






19. Is a provider who sends the patients for testing or treatment






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






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






22. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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






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






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






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






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. 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






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






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






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






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






33. 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






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






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






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






37. 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.






38. 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






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






40. A nonprofit integrated delivery system






41. 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.






42. 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






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






44. 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






45. Is a provider who sends the patients for testing or treatment






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






47. 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






48. 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






49. A patient claim is eligible for medicare and medicaid






50. 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







Sorry!:) No result found.

Can you answer 50 questions in 15 minutes?


Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests



Major Subjects

Tests & Exams


AP
CLEP
DSST
GRE
SAT
GMAT

Browse all subjects

Browse all tests

Most popular tests