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






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






3. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






4. 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






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






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






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






9. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.


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






11. 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






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






13. What the insurance company will consider paying for as defined in the contract.






14. A list of the amount to be paid by an insurance company for each procedure service






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






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






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






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






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






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






21. 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






22. 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.






23. 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






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






25. 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






26. 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






27. 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






28. 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.






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






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






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






32. 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.






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






34. A rule - condition - or requirement






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






36. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






37. 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






38. 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.






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






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






41. 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






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






43. 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)






44. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






45. A list of the amount to be paid by an insurance company for each procedure service






46. 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






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






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






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






50. 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