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. 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






2. 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






3. American Medical Association






4. 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






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






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






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






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






10. 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






11. Medicare's method of paying acute care hospitals for inpatient care






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






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






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






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. 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






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






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






19. Individually identifiable health information






20. 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






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






22. 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.






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






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






25. Billing for services not performed






26. 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.






27. 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






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






29. 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.






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






31. Medical services provided on an outpatient basis






32. 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






33. 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






34. 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.






35. Unauthorized release of information






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






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






38. A patient claim is eligible for medicare and medicaid






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






40. 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.






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






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






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






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






45. A structure for classifying outpatient services and procedures for purpose of payment






46. 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.






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






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






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






50. 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