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 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






2. 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






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






4. 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






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






6. 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






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






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






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






10. 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






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






12. Medical services provided on an outpatient basis






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






14. 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.






15. 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.






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






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






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






20. 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.






21. American Medical Association






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






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






24. Is a provider who sends the patients for testing or 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. 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






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






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






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






30. 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






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






32. Unauthorized release of information






33. 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






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






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






36. 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






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






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






40. 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






41. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






42. 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






43. What the insurance company will consider paying for as defined in the contract.






44. A health insurance enrollee chooses to see an out of network provider without authorization






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






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






47. Billing for services not performed






48. 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






49. Verbal or written agreement that gives approval to some action - situation - or statement.






50. 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