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. 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.






2. American Medical Association






3. 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.






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






5. 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






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






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






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






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






10. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






12. 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






13. 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






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






15. 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.






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






17. 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.






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






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






20. 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.






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






22. 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






23. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






24. 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






25. Medical services provided on an outpatient basis






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






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






28. 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






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






30. 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.






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






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






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






34. 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






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






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






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






38. 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






39. A rule - condition - or requirement






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






41. Is the provider who renders a service to a patient






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






43. A patient claim is eligible for medicare and medicaid






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






45. 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






46. Billing for services not performed






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






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






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






50. American Medical Association