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 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






2. 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






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






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 health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






7. 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






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






9. Billing for services not performed






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






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






12. 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






13. 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






14. Individually identifiable health information






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






16. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






17. 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.






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






19. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






20. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






22. 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.






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






24. 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






25. 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.






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






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






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






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






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






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






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






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. 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






36. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






37. 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






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






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






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






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






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






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






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






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






46. 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






47. 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






48. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






49. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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