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. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






2. 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






3. 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






4. 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






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






7. 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






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






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






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






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






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






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






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






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






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






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






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






19. 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






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






21. An organization of provider sites with a contracted relationship that offer services






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






23. 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






24. 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






25. 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






26. Billing for services not performed






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






28. 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.






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






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






31. 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






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






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






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






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






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






37. 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






38. 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






39. 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.






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






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






42. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






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






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






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






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






47. 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






48. 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






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






50. Verbal or written agreement that gives approval to some action - situation - or statement.