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. 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






2. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






3. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






4. 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






5. 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






6. 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.






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






8. 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






9. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






10. American Medical Association






11. 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






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






13. 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.






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






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. 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






18. 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






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






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






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






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






23. 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






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






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






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






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






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






29. 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






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






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






32. 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.






33. 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)






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






35. A nonprofit integrated delivery system






36. Individually identifiable health information






37. 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






38. 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






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






40. Billing for services not performed






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






42. 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






43. 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






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






45. 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.






46. 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






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






48. 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






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






50. 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