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






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






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


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






5. 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.






6. A patient claim is eligible for medicare and medicaid






7. 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






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






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






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






11. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






12. Individually identifiable health information






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






14. Health Information Portability and Accountability Act






15. 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






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






17. 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






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






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






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






21. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






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






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






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






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






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






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






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






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






30. 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






31. 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






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. 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






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






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






36. 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






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






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






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






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






41. 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






42. 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






43. American Medical Association






44. Billing for services not performed






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






46. Unauthorized release of information






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






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






49. 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.






50. A rule - condition - or requirement