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 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






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






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






4. 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






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






6. The maximum amount a plan pays for a covered service






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






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






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






10. 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






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






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






13. 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






14. Customs - rules of conduct - courtesy - and manners of the medical profession






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






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






17. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






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






19. 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






20. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






21. Medical services provided on an outpatient basis






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






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






24. 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.






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






26. 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






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






28. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






29. 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






30. 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






31. 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






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






33. Individually identifiable health information






34. 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






35. 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






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






37. 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






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






40. 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.






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






42. 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






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






44. 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






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






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






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






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






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






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