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 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






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






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






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






5. 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.






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






7. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






8. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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






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






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






12. 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.






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






14. 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)






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






16. Individually identifiable health information






17. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






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






20. A patient claim is eligible for medicare and medicaid






21. 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






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






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






25. A nonprofit integrated delivery system






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






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 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. 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






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






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






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






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






35. 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.






36. 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






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






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






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






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






41. 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.






42. Someone who is eligible for or receiving benefits under an insurance policy or plan






43. 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






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






45. 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






46. 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






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. 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






49. American Medical Association






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