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






2. 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






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






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






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






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






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






8. 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






9. 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






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






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






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. 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






14. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






15. Billing for services not performed






16. 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






17. 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






18. American Medical Association






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






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






21. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






22. 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






23. 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.






24. 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






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






26. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






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






31. 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






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






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






34. A patient claim is eligible for medicare and medicaid






35. 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






36. Health Information Portability and Accountability Act






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






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






39. 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.






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






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






42. 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.






43. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






44. 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






45. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






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






48. 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






49. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






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