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 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


2. 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






3. 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






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






5. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






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






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






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






9. 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






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






11. 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






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






13. 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






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






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






16. The period of time that payment for Medicare inpatient hospital benefits are available






17. 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.






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






19. 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






20. 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






21. 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






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






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






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






25. 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






26. Unauthorized release of information






27. 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






28. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






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






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






32. 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






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






34. 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.






35. 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.






36. Billing for services not performed






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






38. 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






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






40. A review of the need for inpatient hospital care - completed before the actual admission






41. 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






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. 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






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






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






46. 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.






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






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






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






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