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 complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






2. Health Information Portability and Accountability Act






3. 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






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. 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






6. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






7. Unauthorized release of information






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






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






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. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






13. Billing for services not performed






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






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






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






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






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






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






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






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






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






23. Health Information Portability and Accountability Act






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






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






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






27. American Medical Association






28. 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






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






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






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






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






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






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






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






36. 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






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






38. 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






39. 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.






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






41. 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






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






43. 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






44. 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)






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






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






47. A nonprofit integrated delivery system






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






49. American Medical Association






50. 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