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






2. Billing for services not performed






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






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






5. 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






6. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






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






9. 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






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






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






12. 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






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






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






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






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






17. 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






18. 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






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






20. 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.






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






22. The period of time that payment for Medicare inpatient hospital benefits are available






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






24. 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.






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






26. 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






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






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






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






30. 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






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






32. 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






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






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






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






36. 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






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






38. American Medical Association






39. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






40. 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






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






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






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






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


45. 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






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






47. 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






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






49. 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.






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