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. 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






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






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






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






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






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






7. A patient claim is eligible for medicare and medicaid






8. 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






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






10. 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






11. 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






12. 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.






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






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






15. 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






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






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






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






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






20. Unauthorized release of information






21. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






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






23. 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






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






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






26. 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






27. 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






28. 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






29. Unauthorized release of information






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






31. 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.






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






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






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






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






36. 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






37. 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


38. 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.






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






40. 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






41. A nonprofit integrated delivery system






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






43. American Medical Association






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






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






46. 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






47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






48. 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.






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






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