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






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






3. 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






4. 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






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






6. 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.






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






8. 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






9. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






10. 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






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






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






13. Medicare's method of paying acute care hospitals for inpatient care






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






15. 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.






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






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






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






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






20. Billing for services not performed






21. Billing for services not performed






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






23. 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






24. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






25. 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






26. 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






27. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






28. 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






29. 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






30. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






33. 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






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






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






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






37. Individually identifiable health information






38. 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.






39. Customs - rules of conduct - courtesy - and manners of the medical profession






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






41. 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






42. 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.






43. 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.






44. 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






45. 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






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






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






48. 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.






49. American Medical Association






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