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 patient claim is eligible for medicare and medicaid






2. 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.






3. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






4. 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






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






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






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






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






9. 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.






10. 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






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






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






13. 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






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






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






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






17. 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






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






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






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






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






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






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






24. 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






25. A nonprofit integrated delivery system






26. 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.






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






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






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






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






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






32. 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.






33. Medical services provided on an outpatient basis






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






35. 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






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






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






38. 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.






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






40. 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






41. 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






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






43. 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






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






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






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






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






48. 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






49. A rule - condition - or requirement






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