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. 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






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






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






5. 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






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






7. 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.






8. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






10. A structure for classifying outpatient services and procedures for purpose of payment






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






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






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






14. 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






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






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






17. 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.






18. A nonprofit integrated delivery system






19. 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






20. 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






21. 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






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






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






24. 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






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






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






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






28. 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)






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






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






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






32. Health Information Portability and Accountability Act






33. 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






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






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






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






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






38. 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.






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






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






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






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






43. A patient claim is eligible for medicare and medicaid






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






45. Health Information Portability and Accountability Act






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






47. 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






48. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






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