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






2. 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






3. Health Information Portability and Accountability Act






4. 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.






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






6. Billing for services not performed






7. 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.






8. 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






9. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






10. 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






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






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






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






14. 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.






15. 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






16. 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






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. 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


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






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






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






22. 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






23. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






25. 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.






26. 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






27. 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






28. 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






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






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






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






32. 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.






33. 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






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






35. 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






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






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






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






39. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






40. The amount of actual money available to the medical practice






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






42. 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






43. 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






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






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






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






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






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






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






50. 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.







Sorry!:) No result found.

Can you answer 50 questions in 15 minutes?


Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests



Major Subjects

Tests & Exams


AP
CLEP
DSST
GRE
SAT
GMAT

Browse all subjects

Browse all tests

Most popular tests