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 amount of actual money available to the medical practice






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






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






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






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






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






7. 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






8. 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






9. 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






10. Individually identifiable health information






11. 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






12. 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






13. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






14. Medical services provided on an outpatient basis






15. 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






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






17. 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






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






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






20. 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


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






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






23. 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






24. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






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






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






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






28. 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






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






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






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






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






33. 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






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






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






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






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






38. 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






39. Billing for services not performed






40. 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






41. Health Information Portability and Accountability Act






42. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






43. 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






44. Unauthorized release of information






45. 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






46. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






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






49. 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






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