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 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






2. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






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






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






5. 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.






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






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






8. A patient claim is eligible for medicare and medicaid






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






10. 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






11. Individually identifiable health information






12. 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






13. 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






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






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






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






17. 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






18. Unauthorized release of information






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






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. 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






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






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






24. 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






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






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






27. A rule - condition - or requirement






28. 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






29. 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.






30. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






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






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






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






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






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






37. 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


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






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






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






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






42. 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






43. Verbal or written agreement that gives approval to some action - situation - or statement.






44. 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






45. 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.






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






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






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






49. 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






50. 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