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 monthly fee paid by the insured for specific medical insurance coverage






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






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






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






6. 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






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






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






9. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






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






12. 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






13. 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






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






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






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






17. Health Information Portability and Accountability Act






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






19. 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.






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






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






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






23. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






24. 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






25. 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.






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






27. 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






28. 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






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






30. 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.






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






32. A patient claim is eligible for medicare and medicaid






33. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






34. 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






35. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






36. Individually identifiable health information






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






38. A rule - condition - or requirement






39. American Medical Association






40. 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






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






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






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






44. 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






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






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






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






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






49. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






50. 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