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






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






3. 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






4. 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






5. 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.






6. Medical services provided on an outpatient basis






7. Health Information Portability and Accountability Act






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






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






10. 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


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






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






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






14. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






15. 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






16. 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






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






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






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






20. 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.






21. 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






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






23. Billing for services not performed






24. 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






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






26. 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






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






28. 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






29. 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






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






31. 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






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






33. 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






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






35. Unauthorized release of information






36. 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






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






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






39. 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






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






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






42. 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






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






44. The condition of being secluded from the presence or view of others.






45. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






46. 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






47. 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






48. 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.






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






50. 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