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 is part of am managed care plan that provides all primary health care services to members of the plan






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






3. 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






4. Customs - rules of conduct - courtesy - and manners of the medical profession






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






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






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






8. Health Information Portability and Accountability Act






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






10. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






11. 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






12. 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






13. 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






14. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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






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






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






18. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






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






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






22. 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






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






24. 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






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






26. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






27. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






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






30. 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






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






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






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






34. 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


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






37. Billing for services not performed






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






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






40. 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






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






42. 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






43. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






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






46. 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






47. A rule - condition - or requirement






48. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






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