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. Someone who is eligible for or receiving benefits under an insurance policy or plan






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






3. 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






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






5. 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






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






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






8. 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






9. 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






10. 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






11. 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






12. 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






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 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






15. 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






16. 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






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






18. A patient claim is eligible for medicare and medicaid






19. A nonprofit integrated delivery system






20. Someone who is eligible for or receiving benefits under an insurance policy or plan






21. 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






22. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






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






25. 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.






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






27. 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






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






29. Medical services provided on an outpatient basis






30. 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






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






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






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






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






36. 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






37. 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


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






39. Billing for services not performed






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






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






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






43. 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






44. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






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






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






49. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






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