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






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






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






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






5. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






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






8. 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.






9. 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






10. 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






11. 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.






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






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






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






15. Is the provider who renders a service to a patient






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






17. American Medical Association






18. 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.






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






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






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






23. 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






24. 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






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






26. 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






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






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






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






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






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






32. 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)






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






34. 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






35. 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.






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






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






38. 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






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






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






41. 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






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






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






44. 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)






45. 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






46. 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.






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






48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






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