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






2. 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






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






4. 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.






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






6. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






7. 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






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






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






10. A rule - condition - or requirement






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






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






13. 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






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






15. 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






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






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






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






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






21. 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






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






23. 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






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






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






26. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






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






28. 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






29. A nonprofit integrated delivery system






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






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






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






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






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






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






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






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






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






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






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






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






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






43. 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






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






45. 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






46. An intentional misrepresentation of the facts to deceive or mislead another.






47. 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.






48. 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.






49. 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






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