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 nonprofit integrated delivery system






2. 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.






3. 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






4. 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






5. 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






6. 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.






7. 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


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






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






10. 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






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






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






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






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






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






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






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






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 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






20. 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






21. A patient claim is eligible for medicare and medicaid






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






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






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






25. 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






26. 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






27. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






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






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






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






31. American Medical Association






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






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






34. 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






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






36. 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






37. 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






38. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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






40. 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






41. A rule - condition - or requirement






42. Billing for services not performed






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






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






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. The maximum amount a plan pays for a covered service






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






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






50. 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.