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






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






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






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






5. 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






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






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






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






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






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






11. 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.






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






13. 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






14. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






16. 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






17. 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.






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






19. American Medical Association






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






21. 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






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






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






24. A willful act by an employee of taking possession of an employer's money






25. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






26. 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






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






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






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






31. A nonprofit integrated delivery system






32. 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






33. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






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






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






37. 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






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






39. 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.






40. 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






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. 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






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






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






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






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






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






49. Health Information Portability and Accountability Act






50. A rule - condition - or requirement