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. 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






2. 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






3. Unauthorized release of information






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






5. 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






6. 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






7. 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.






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






9. 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.






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






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






12. 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






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






14. Billing for services not performed






15. Health Information Portability and Accountability Act






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






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






18. 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.






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






20. 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)






21. 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.






22. 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






23. Unauthorized release of information






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






25. 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






26. A patient claim is eligible for medicare and medicaid






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






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






29. 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.






30. 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






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






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






33. Someone who is eligible for or receiving benefits under an insurance policy or plan






34. A nonprofit integrated delivery system






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






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






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






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






39. 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






40. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






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. 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.






43. 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






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






45. 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






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






47. A nonprofit integrated delivery system






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






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






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