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. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






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






3. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






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






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






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






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






8. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






10. A patient claim is eligible for medicare and medicaid






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






12. A nonprofit integrated delivery system






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






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






15. 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






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






17. 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






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






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






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






21. 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.






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






23. 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






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






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






26. Billing for services not performed






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






28. 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






29. 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






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






31. 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






32. 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.






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






34. 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






35. American Medical Association






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






37. 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.






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






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






40. 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






41. 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






42. Medical services provided on an outpatient basis






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






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






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






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






47. 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






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






49. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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