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






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






3. 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






4. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






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






6. 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.






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






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






9. 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






10. Billing for services not performed






11. 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






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






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






14. 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






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






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. 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






18. 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






19. 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






20. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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






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






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






24. 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






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






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






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






28. 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.






29. 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






30. 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






31. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






32. 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






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. 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






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






36. Health Information Portability and Accountability Act






37. 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






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






39. 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






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






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






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






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






44. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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






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






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






49. A clinic that is owned by the HMO and the physicians are employees of the HMO






50. 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