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






2. A patient claim is eligible for medicare and medicaid






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






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






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






6. 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






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






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






9. 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






10. 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.






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






12. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






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






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






16. 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






17. 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






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






19. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






20. 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






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






22. 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






23. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






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






26. 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






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. The maximum amount a plan pays for a covered service






29. A nonprofit integrated delivery system






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






31. A rule - condition - or requirement






32. 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






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






34. 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






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






36. Individually identifiable health information






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






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






39. An intentional misrepresentation of the facts to deceive or mislead another.






40. 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






41. Medical services provided on an outpatient basis






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. 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






44. A health insurance enrollee chooses to see an out of network provider without authorization






45. 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






46. 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.






47. Medical services provided on an outpatient basis






48. A patient claim is eligible for medicare and medicaid






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






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