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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.
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. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
claim
(UCR) Usual - Customary and Reasonable
referring physician
2. 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
(POS) Point-of Service Plan
hmo
breach of confidential communication
econdary Payer
3. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(OOPs) Out of Pocket Costs/Expenses
Individually identifiable health information
electronic media
(DCI) Duplicate Coverage Inquiry
4. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
(DME) Durable Medical Equipment
(COB) Coordination of Benefits
Participating Provider
5. American Medical Association
AMA
Consent form
(EPO) Exclusive Provider Organization
Beneficiary
6. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
closed panel HMO
security officer
(DME) Durable Medical Equipment
7. 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
Amblatory Care
business associate
(ABN) Advance Beneficiary Notice
confidentiality
8. Unauthorized release of information
(ERISA) Employee Retirement Income Security Act of 1974
Privileged information
breach of confidential communication
Claim
9. A patient claim is eligible for medicare and medicaid
HIPAA
(PAC) Pre- Admission Certification
crossover claim
Maximum Out Of Pocket
10. The amount of actual money available to the medical practice
(ERISA) Employee Retirement Income Security Act of 1974
(UR) Utilization review
cash flow
ids
11. 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
Assignment & Authorization
Pre-existing Condition Exclusion
(ERISA) Employee Retirement Income Security Act of 1974
Privileged information
12. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(APC) Ambulatory Patient Classifications
confidentiality
(AOB) Assignment of Benefits
Security Rule
13. Individually identifiable health information
confidentiality
(UR) Utilization review
IIHI
Amblatory Care
14. An organization of provider sites with a contracted relationship that offer services
(DRG's)
Security Rule
ids
Beneficiary
15. 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.
breach of confidential communication
(COBRA)
Open Enrollment
business associate
16. 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
claim
Privileged information
HIPAA
(PCN) Primary Care Network
17. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(UR) Utilization review
Resonable Charge
ee schedule
ethics
18. 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
AMA
Network
(DME) Durable Medical Equipment
Maximum Out Of Pocket
19. 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
pos
(PEC) Pre-existing condition
referring physician
fraud
20. 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
(DOS) Date of Service
nonprivileged information
ids
transaction
21. American Medical Association
pcp
covered entity
AMA
HIPAA
22. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
medical foundation
electronic media
Consent form
business associate
23. 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
Pre-certification
(APC) Ambulatory Patient Classifications
Participating Provider
(COB) Coordination of Benefits
24. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(APC) Ambulatory Patient Classifications
(UCR) Usual - Customary and Reasonable
crossover claim
(UR) Utilization review
25. 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
Out of Network (OON)
(AOB) Assignment of Benefits
(EPO) Exclusive Provider Organization
(COBRA)
26. Standards of conduct generally accepted as a moral guide for behavior.
ethics
Subscriber
security officer
ppo
27. 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
Referral
(POS) Point-of Service Plan
epo
open panel HMO
28. Medical services provided on an outpatient basis
epo
Amblatory Care
ethics
preauthorization
29. 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
Individually identifiable health information
prepaid plan
Deductible
30. A structure for classifying outpatient services and procedures for purpose of payment
(PPS) Hospital Impatient Prospective Payment System
(APC) Ambulatory Patient Classifications
pos
breach of confidential communication
31. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
ids
Privacy officer
abuse
authorization form
32. A rule - condition - or requirement
Referral
Amblatory Care
(Non-par) Non-Participating Provider
Standard
33. 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 officer
AMA
pcp
Security Rule
34. 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
cash flow
consulting physician
Security Rule
35. 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
(PCP) Primary Care Physician
Open Enrollment
econdary Payer
(COB) Coordination of Benefits
36. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
fraud
Specialist
Notice of Privacy Practices
37. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
Pre-existing Condition Exclusion
(APC) Ambulatory Patient Classifications
Resonable Charge
Open Enrollment
38. A nonprofit integrated delivery system
crossover claim
Medigap Insurance
premium
medical foundation
39. The period of time that payment for Medicare inpatient hospital benefits are available
preauthorization
benefit period
health care provider
crossover claim
40. 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
Pre-existing Condition Exclusion
(DOS) Date of Service
Confidential communication
premium
41. 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
Pre-certification
epo
AMA
Sub-acute Care
42. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(TPA) Third Party Administrator
(DCI) Duplicate Coverage Inquiry
pcp
Referral
43. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
pos
benefit period
Beneficiary
44. 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
security officer
HIPAA
Protected health information
Preauthorization
45. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
benefit period
cash flow
consulting physician
prepaid plan
46. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
complience
ee schedule
(POS) Point-of Service Plan
Network
47. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Preauthorization
referring physician
Claim
(AOB) Assignment of Benefits
48. 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.
HIPAA
benefit period
security officer
Network
49. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
electronic media
Out of Network (OON)
state preemption
clearinghouse
50. Is a provider who sends the patients for testing or treatment
(OOPs) Out of Pocket Costs/Expenses
security officer
consulting physician
referring physician