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. 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






2. Individually identifiable health information






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






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






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






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






7. 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






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






9. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






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






11. 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






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






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






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






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






16. 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






17. 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






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






19. 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






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






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






22. 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






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






24. A nonprofit integrated delivery system






25. 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






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






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






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. 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.






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






31. 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






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






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






34. 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






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. Is the provider who renders a service to a patient






37. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






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






40. 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






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






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






43. 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






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






45. 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






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






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






48. 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.






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






50. American Medical Association