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






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






3. 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






4. 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






5. 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






6. 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






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






8. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






9. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






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






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. 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






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






14. 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.






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






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






17. 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.






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






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






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






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






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






23. Individually identifiable health information






24. Health Information Portability and Accountability Act






25. Unauthorized release of information






26. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






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






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






29. 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


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






31. 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






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






33. 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






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






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






36. Individually identifiable health information






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






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






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






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






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






42. 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.






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






44. 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






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






46. 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






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






48. 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






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






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