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. The maximum amount a plan pays for a covered service






2. 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.






3. 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






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. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






7. Unauthorized release of information






8. 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






9. 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.






10. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






13. Unauthorized release of information






14. 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






15. 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






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






17. 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






18. 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






19. 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






20. 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






21. 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.






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






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






24. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






26. 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.






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






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






29. 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






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






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






32. 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






33. 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






34. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






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






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






37. Health Information Portability and Accountability Act






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






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






40. American Medical Association






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






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






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






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






45. 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)






46. 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


47. 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






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






49. 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






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







Sorry!:) No result found.

Can you answer 50 questions in 15 minutes?


Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests



Major Subjects

Tests & Exams


AP
CLEP
DSST
GRE
SAT
GMAT

Browse all subjects

Browse all tests

Most popular tests