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. Is the provider who renders a service to a patient






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






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






4. 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






5. 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






6. 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






7. 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






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






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






10. 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






11. 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.






12. 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






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






14. 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






15. 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






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






17. A nonprofit integrated delivery system






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






19. 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






20. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






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






23. 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






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






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






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






27. 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






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






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






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






31. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






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






34. 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






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






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






37. 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






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






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






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






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






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






43. 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


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






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






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






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






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






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






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