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 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






2. 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






3. 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






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. 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.






6. 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






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






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






9. 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)






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






11. 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






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






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






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






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






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






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






18. 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






19. 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






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






21. 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.






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






23. 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






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






25. 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.






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






27. 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






28. A monthly fee paid by the insured for specific medical insurance coverage






29. 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.






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






31. 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






32. Health Information Portability and Accountability Act






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






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






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






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






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






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






39. 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






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






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






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






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






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






45. 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






46. 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






47. Medical services provided on an outpatient basis






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






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






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