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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. 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
ee schedule
Covered Expenses
breach of confidential communication
(POS) Point-of Service Plan
2. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Protected health information
(UR) Utilization review
Covered Expenses
(DME) Durable Medical Equipment
3. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
breach of confidential communication
electronic media
(DRG's)
phantom billing
4. Someone who is eligible for or receiving benefits under an insurance policy or plan
(DOS) Date of Service
Beneficiary
(UR) Utilization review
Coordinated Coverage
5. 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
Out of Network (OON)
preauthorization
Confidential communication
6. The condition of being secluded from the presence or view of others.
complience plan
(AOB) Assignment of Benefits
(DCI) Duplicate Coverage Inquiry
privacy
7. 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
(COBRA)
deductible
Allowed Expenses
(DCI) Duplicate Coverage Inquiry
8. Is the provider who renders a service to a patient
Treating or performing physician
pcp
medical foundation
(AOB) Assignment of Benefits
9. A structure for classifying outpatient services and procedures for purpose of payment
Assignment & Authorization
econdary Payer
(APC) Ambulatory Patient Classifications
hmo
10. 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
Protected health information
privacy
(ABN) Advance Beneficiary Notice
cash flow
11. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
Preauthorization
(PCP) Primary Care Physician
covered entity
12. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Treating or performing physician
complience plan
ppo
ee schedule
13. 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
abuse
Supplementary Medical Insurance
crossover claim
Consent form
14. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
ethics
prepaid plan
(AOB) Assignment of Benefits
15. 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
consulting physician
Coordinated Coverage
Sub-acute Care
subscriber
16. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
complience
claim
disclosure
Amblatory Care
17. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(EPO) Exclusive Provider Organization
confidentiality
Consent form
abuse
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
Treating or performing physician
electronic media
Resonable Charge
epo
19. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
open panel HMO
e-health information management
deductible
(OOPs) Out of Pocket Costs/Expenses
20. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Confidential communication
phantom billing
(UR) Utilization review
(EPO) Exclusive Provider Organization
21. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
AMA
Pre-certification
closed panel HMO
22. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
deductible
Preauthorization
consent
23. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
consent
Maximum Out Of Pocket
(DME) Durable Medical Equipment
24. Billing for services not performed
AMA
phantom billing
ee schedule
Standard
25. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
(OOPs) Out of Pocket Costs/Expenses
Allowed Expenses
(COBRA)
26. 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
prepaid plan
(DCI) Duplicate Coverage Inquiry
(ABN) Advance Beneficiary Notice
(PCN) Primary Care Network
27. 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
disclosure
e-health information management
Specialist
28. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
AMA
(PPS) Hospital Impatient Prospective Payment System
consulting physician
ppo
29. A review of the need for inpatient hospital care - completed before the actual admission
pos
(PAC) Pre- Admission Certification
crossover claim
Security Rule
30. 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
Network
(OOPs) Out of Pocket Costs/Expenses
Supplementary Medical Insurance
Security Rule
31. 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
Experimental Procedures
benefit period
(PCP) Primary Care Physician
open panel HMO
32. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Supplementary Medical Insurance
pos
Confidential communication
transaction
33. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
etiquette
Individually identifiable health information
medical foundation
Out of Network (OON)
34. A list of the amount to be paid by an insurance company for each procedure service
consulting physician
nonprivileged information
ee schedule
ordering physician
35. 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)
econdary Payer
consent
authorization form
Consent form
36. 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-certification
Covered Expenses
(Non-par) Non-Participating Provider
Pre-existing Condition Exclusion
37. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
ee schedule
(EPO) Exclusive Provider Organization
(PAC) Pre- Admission Certification
(OOPs) Out of Pocket Costs/Expenses
38. 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
(DOS) Date of Service
complience plan
Specialist
(PCP) Primary Care Physician
39. 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
Deductible
(AOB) Assignment of Benefits
open panel HMO
phantom billing
40. 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
(DRG's)
econdary Payer
electronic media
41. Is a provider who sends the patients for testing or treatment
Deductible
Sub-acute Care
referring physician
Network
42. A clinic that is owned by the HMO and the physicians are employees of the HMO
Specialist
closed panel HMO
Out of Network (OON)
Privacy officer
43. 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.
Subscriber
attending physician
(DME) Durable Medical Equipment
security officer
44. 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.
Participating Provider
ids
open panel HMO
Protected health information
45. Is the provider who renders a service to a patient
Claim
Treating or performing physician
health care provider
Experimental Procedures
46. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
benefit period
ordering physician
health care provider
(DME) Durable Medical Equipment
47. 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)
premium
Open Enrollment
Consent form
Coordinated Coverage
48. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
preauthorization
Protected health information
(COB) Coordination of Benefits
disclosure
49. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
premium
(OOPs) Out of Pocket Costs/Expenses
Assignment & Authorization
clearinghouse
50. 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.
ordering physician
(COBRA)
(UCR) Usual - Customary and Reasonable
health care provider