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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. 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
(DME) Durable Medical Equipment
abuse
Embezzlement
Privileged information
2. Medicare's method of paying acute care hospitals for inpatient care
Sub-acute Care
(ERISA) Employee Retirement Income Security Act of 1974
(PPS) Hospital Impatient Prospective Payment System
(PAC) Pre- Admission Certification
3. 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
(PEC) Pre-existing condition
(OOPs) Out of Pocket Costs/Expenses
econdary Payer
Standard
4. 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.
Allowed Expenses
Consent form
IIHI
health care provider
5. 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
(PPS) Hospital Impatient Prospective Payment System
ordering physician
ppo
HIPAA
6. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Allowed Expenses
preauthorization
prepaid plan
Deductible
7. 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.
phantom billing
electronic media
state preemption
Supplementary Medical Insurance
8. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
epo
nonprivileged information
preauthorization
9. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(ERISA) Employee Retirement Income Security Act of 1974
(DCI) Duplicate Coverage Inquiry
(TPA) Third Party Administrator
epo
10. 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
Out of Network (OON)
abuse
pos
complience plan
11. 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
Participating Provider
Network
attending physician
(PCN) Primary Care Network
12. Is a provider who sends the patients for testing or treatment
referring physician
(UR) Utilization review
Privacy officer
disclosure
13. A monthly fee paid by the insured for specific medical insurance coverage
premium
(APC) Ambulatory Patient Classifications
deductible
Standard
14. 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.
e-health information management
Referral
Network
Privacy officer
15. 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
(POS) Point-of Service Plan
Resonable Charge
subscriber
Consent form
16. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations
authorization form
Sub-acute Care
(ERISA) Employee Retirement Income Security Act of 1974
(PEC) Pre-existing condition
17. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Network
Specialist
premium
18. 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
open panel HMO
(PEC) Pre-existing condition
breach of confidential communication
Medigap Insurance
19. 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
Allowed Expenses
ppo
Experimental Procedures
(OOPs) Out of Pocket Costs/Expenses
20. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
benefit period
electronic media
epo
etiquette
21. 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
Covered Expenses
Preauthorization
Participating Provider
(UCR) Usual - Customary and Reasonable
22. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
consent
attending physician
(OOPs) Out of Pocket Costs/Expenses
Security Rule
23. 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
benefit period
hmo
(COB) Coordination of Benefits
(POS) Point-of Service Plan
24. 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
Security Rule
nonprivileged information
Referral
Out of Network (OON)
25. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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26. 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.
Individually identifiable health information
HIPAA
(Non-par) Non-Participating Provider
Privileged information
27. 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
Network
confidentiality
epo
ordering physician
28. 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.
ordering physician
Notice of Privacy Practices
(UCR) Usual - Customary and Reasonable
Out of Network (OON)
29. 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
Experimental Procedures
Standard
(Non-par) Non-Participating Provider
(DRG's)
30. 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
self-referral
(DCI) Duplicate Coverage Inquiry
prepaid plan
confidentiality
31. 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.
Pre-existing Condition Exclusion
Out of Network (OON)
state preemption
privacy
32. 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
covered entity
Claim
Specialist
(UCR) Usual - Customary and Reasonable
33. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(DOS) Date of Service
(DRG's)
Beneficiary
34. 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
Individually identifiable health information
fraud
Embezzlement
(PCN) Primary Care Network
35. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
cash flow
pos
Subscriber
36. 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
epo
prepaid plan
(PCP) Primary Care Physician
(TPA) Third Party Administrator
37. 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
Pre-certification
Notice of Privacy Practices
authorization form
(Non-par) Non-Participating Provider
38. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Supplementary Medical Insurance
Network
(ABN) Advance Beneficiary Notice
(DCI) Duplicate Coverage Inquiry
39. 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
nonprivileged information
phantom billing
(APC) Ambulatory Patient Classifications
attending physician
40. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
prepaid plan
e-health information management
attending physician
complience
41. Is the provider who renders a service to a patient
Treating or performing physician
claim
Maximum Out Of Pocket
Amblatory Care
42. The transmission of information between two parties to carry out financial or administrative activities related to health care.
electronic media
pos
transaction
subscriber
43. Is a provider who sends the patients for testing or treatment
Medigap Insurance
referring physician
referral
Medigap Insurance
44. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(PAC) Pre- Admission Certification
(POS) Point-of Service Plan
attending physician
45. An organization of provider sites with a contracted relationship that offer services
Privileged information
state preemption
ids
(COBRA)
46. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Confidential communication
electronic media
Referral
nonprivileged information
47. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
Claim
(POS) Point-of Service Plan
Treating or performing physician
48. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(UCR) Usual - Customary and Reasonable
Experimental Procedures
clearinghouse
complience plan
49. Medical services provided on an outpatient basis
Out of Network (OON)
phantom billing
Amblatory Care
(DRG's)
50. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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