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






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






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






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






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






6. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






8. A patient claim is eligible for medicare and medicaid






9. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






10. 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.






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






13. 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






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






15. Billing for services not performed






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






17. A rule - condition - or requirement






18. Health Information Portability and Accountability Act






19. 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






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






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






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






23. 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






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






25. 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)






26. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






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






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






29. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






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






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






32. 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






33. 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






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






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






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






37. 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






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






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






40. 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






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






42. 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






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






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






45. 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






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






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






48. 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






49. 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






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