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






2. 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






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






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






5. 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






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






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






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






9. 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


10. 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)






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






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






13. 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.






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






15. 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






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






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






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






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






20. 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






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






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






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






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






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






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






27. 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






28. 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






29. 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






30. Health Information Portability and Accountability Act






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






32. 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.






33. 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






34. 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






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






36. 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






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






38. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






40. 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.






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






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






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






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






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






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






47. 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






48. Unauthorized release of information






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






50. 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.