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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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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. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
prepaid plan
Embezzlement
Standard
disclosure
2. Unauthorized release of information
(ABN) Advance Beneficiary Notice
breach of confidential communication
Coordinated Coverage
Amblatory Care
3. 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.
Privileged information
consulting physician
Medigap Insurance
Experimental Procedures
4. 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
hmo
consulting physician
Participating Provider
Covered Expenses
5. Is a provider who sends the patients for testing or treatment
attending physician
(ERISA) Employee Retirement Income Security Act of 1974
ordering physician
referring physician
6. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
state preemption
(APC) Ambulatory Patient Classifications
(PCN) Primary Care Network
7. Medical services provided on an outpatient basis
Amblatory Care
attending physician
Pre-existing Condition Exclusion
health care provider
8. 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
authorization form
(UCR) Usual - Customary and Reasonable
(OOPs) Out of Pocket Costs/Expenses
prepaid plan
9. 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
(DRG's)
cash flow
(COBRA)
Subscriber
10. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(UR) Utilization review
Participating Provider
clearinghouse
preauthorization
11. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Consent form
Covered Expenses
preauthorization
Embezzlement
12. 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
(UR) Utilization review
Open Enrollment
(UCR) Usual - Customary and Reasonable
(Non-par) Non-Participating Provider
13. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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14. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(OOPs) Out of Pocket Costs/Expenses
hmo
complience plan
pcp
15. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
(PAC) Pre- Admission Certification
Privileged information
referring physician
16. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(UR) Utilization review
Maximum Out Of Pocket
hmo
Subscriber
17. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
(DME) Durable Medical Equipment
Protected health information
Preauthorization
Assignment & Authorization
18. 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
Privacy officer
(PCP) Primary Care Physician
Resonable Charge
(COB) Coordination of Benefits
19. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Embezzlement
(EPO) Exclusive Provider Organization
(AOB) Assignment of Benefits
Deductible
20. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(DME) Durable Medical Equipment
ordering physician
cash flow
subscriber
21. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
transaction
ids
(PPS) Hospital Impatient Prospective Payment System
Resonable Charge
22. American Medical Association
Pre-certification
ethics
AMA
Participating Provider
23. A nonprofit integrated delivery system
e-health information management
medical foundation
Pre-existing Condition Exclusion
ethics
24. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
AMA
Medigap Insurance
pcp
25. 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
(UCR) Usual - Customary and Reasonable
Standard
Open Enrollment
fraud
26. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(PCP) Primary Care Physician
subscriber
referral
ppo
27. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Assignment & Authorization
hmo
self-referral
breach of confidential communication
28. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Amblatory Care
complience
(TPA) Third Party Administrator
Out of Network (OON)
29. 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.
health care provider
subscriber
electronic media
(APC) Ambulatory Patient Classifications
30. Medical staff member who is legally responsible for the care and treatment given to a patient.
medical foundation
open panel HMO
attending physician
ids
31. 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.
business associate
fraud
(TPA) Third Party Administrator
attending physician
32. 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
(DRG's)
(PCN) Primary Care Network
hmo
(PEC) Pre-existing condition
33. Is the provider who renders a service to a patient
hmo
ppo
Treating or performing physician
Subscriber
34. 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
abuse
abuse
(AOB) Assignment of Benefits
privacy
35. The dates of healthcare services were provided to the beneficiary
referral
(DOS) Date of Service
preauthorization
subscriber
36. 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
consulting physician
nonprivileged information
claim
(ERISA) Employee Retirement Income Security Act of 1974
37. A review of the need for inpatient hospital care - completed before the actual admission
Covered Expenses
(PAC) Pre- Admission Certification
Preauthorization
(DCI) Duplicate Coverage Inquiry
38. Health Information Portability and Accountability Act
Notice of Privacy Practices
HIPAA
(PCP) Primary Care Physician
Out of Network (OON)
39. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Referral
cash flow
attending physician
(DCI) Duplicate Coverage Inquiry
40. 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
Resonable Charge
Confidential communication
covered entity
Open Enrollment
41. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Protected health information
Referral
Medigap Insurance
phantom billing
42. 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.
(DME) Durable Medical Equipment
pcp
Notice of Privacy Practices
nonprivileged information
43. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
epo
Maximum Out Of Pocket
premium
Individually identifiable health information
44. A rule - condition - or requirement
pcp
Standard
(APC) Ambulatory Patient Classifications
closed panel HMO
45. 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
prepaid plan
Pre-certification
Covered Expenses
Security Rule
46. 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.
Notice of Privacy Practices
authorization form
self-referral
Embezzlement
47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
Experimental Procedures
complience
Pre-certification
48. A health insurance enrollee chooses to see an out of network provider without authorization
subscriber
self-referral
premium
crossover claim
49. 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
(DRG's)
security officer
privacy
Security Rule
50. A willful act by an employee of taking possession of an employer's money
Consent form
Medigap Insurance
Embezzlement
subscriber