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






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






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






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. The amount of actual money available to the medical practice






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






7. 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.






8. 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






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






10. 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)






11. A nonprofit integrated delivery system






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






13. 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






14. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


15. 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






16. 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.






17. 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






18. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






19. 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






20. 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






21. 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.






22. American Medical Association






23. 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






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






25. 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.






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






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






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






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






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






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






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






33. 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.






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






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






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






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






38. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






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






41. 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)






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






43. 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






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






45. A patient claim is eligible for medicare and medicaid






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






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






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






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






50. 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