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






2. 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






3. 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.






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






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






6. 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.






7. 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






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






9. 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.






10. 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






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






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






13. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






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






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






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






18. A nonprofit integrated delivery system






19. 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.






20. 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.






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






22. The transmission of information between two parties to carry out financial or administrative activities related to health care.






23. 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






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






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






26. 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






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






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






29. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






31. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






32. Medical services provided on an outpatient basis






33. 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






34. 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






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






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






37. 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






38. Health Information Portability and Accountability Act






39. 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






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






41. 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






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






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






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






45. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






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






48. Individually identifiable health information






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






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