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 sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






3. 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






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






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






6. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






7. 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.






8. 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






9. Unauthorized release of information






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






11. 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






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






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






14. 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.






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






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






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






18. 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






19. 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






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






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






22. 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)






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






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






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






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






27. 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






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






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






30. 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






31. Medical services provided on an outpatient basis






32. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


33. 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






34. 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.






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






36. 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






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






38. Billing for services not performed






39. 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






40. 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






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






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






43. 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.






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






45. 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






46. 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






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






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






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






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