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






2. 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






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






4. 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






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






7. 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






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






9. Individually identifiable health information






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






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






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






13. 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






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






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






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






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






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






19. 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.






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






21. 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






22. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






23. 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






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






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






26. 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






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






28. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






30. 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.






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






32. 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






33. 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






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






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






36. 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






37. 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






38. Unauthorized release of information






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






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






41. A patient claim is eligible for medicare and medicaid






42. 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






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






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






45. 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






46. A patient claim is eligible for medicare and medicaid






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






48. 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






49. Unauthorized release of information






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