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






2. 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






3. 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






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






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






6. 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






7. A rule - condition - or requirement






8. 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






9. 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






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






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






12. Billing for services not performed






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






14. 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






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






16. 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






17. 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






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






19. 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






20. A nonprofit integrated delivery system






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






22. 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






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






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






25. Health Information Portability and Accountability Act






26. 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






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






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






29. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






30. 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


31. 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






32. 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






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






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






36. 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






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






38. Unauthorized release of information






39. 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






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






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






42. 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)






43. American Medical Association






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






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






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






47. 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.






48. A patient claim is eligible for medicare and medicaid






49. 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






50. 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