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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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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 portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(PEC) Pre-existing condition
Individually identifiable health information
Beneficiary
(OOPs) Out of Pocket Costs/Expenses
2. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Out of Network (OON)
(DRG's)
Specialist
(TPA) Third Party Administrator
3. 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
consulting physician
(TPA) Third Party Administrator
deductible
Supplementary Medical Insurance
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
business associate
Assignment & Authorization
Participating Provider
security officer
5. 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
epo
self-referral
(DME) Durable Medical Equipment
(APC) Ambulatory Patient Classifications
6. 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
transaction
Pre-existing Condition Exclusion
Allowed Expenses
Security Rule
7. Is a provider who sends the patients for testing or treatment
Covered Expenses
referring physician
Open Enrollment
IIHI
8. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Consent form
(POS) Point-of Service Plan
(PAC) Pre- Admission Certification
(EPO) Exclusive Provider Organization
9. Billing for services not performed
claim
phantom billing
(COBRA)
Privileged information
10. 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
(DRG's)
Assignment & Authorization
epo
(PPS) Hospital Impatient Prospective Payment System
11. 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
Supplementary Medical Insurance
Preauthorization
(UCR) Usual - Customary and Reasonable
Embezzlement
12. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(DOS) Date of Service
business associate
Resonable Charge
Referral
13. 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
HIPAA
pos
Sub-acute Care
14. 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
Resonable Charge
(PPS) Hospital Impatient Prospective Payment System
premium
15. 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)
Protected health information
Consent form
Amblatory Care
HIPAA
16. A nonprofit integrated delivery system
Supplementary Medical Insurance
Privacy officer
Preauthorization
medical foundation
17. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
etiquette
(PPS) Hospital Impatient Prospective Payment System
AMA
Pre-certification
18. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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19. Customs - rules of conduct - courtesy - and manners of the medical profession
pcp
(POS) Point-of Service Plan
ethics
etiquette
20. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
health care provider
preauthorization
ethics
Medigap Insurance
21. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
Consent form
(OOPs) Out of Pocket Costs/Expenses
(DOS) Date of Service
22. 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.
e-health information management
security officer
Standard
Coordinated Coverage
23. 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
(UCR) Usual - Customary and Reasonable
(COBRA)
(DOS) Date of Service
epo
24. 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
self-referral
deductible
(EPO) Exclusive Provider Organization
Pre-existing Condition Exclusion
25. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
crossover claim
Treating or performing physician
Embezzlement
claim
26. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(DOS) Date of Service
self-referral
(DOS) Date of Service
27. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
consulting physician
claim
Allowed Expenses
abuse
28. American Medical Association
confidentiality
privacy
pcp
AMA
29. A rule - condition - or requirement
Standard
Individually identifiable health information
Covered Expenses
preauthorization
30. 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
Privacy officer
(PCN) Primary Care Network
31. What the insurance company will consider paying for as defined in the contract.
(PCP) Primary Care Physician
Covered Expenses
breach of confidential communication
(DME) Durable Medical Equipment
32. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(UCR) Usual - Customary and Reasonable
epo
transaction
complience plan
33. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Security Rule
Maximum Out Of Pocket
electronic media
consent
34. An intentional misrepresentation of the facts to deceive or mislead another.
prepaid plan
fraud
(OOPs) Out of Pocket Costs/Expenses
open panel HMO
35. 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.
Pre-existing Condition Exclusion
health care provider
HIPAA
transaction
36. A privileged communication that may be disclosed only with the patient's permission.
econdary Payer
transaction
Confidential communication
Supplementary Medical Insurance
37. The dates of healthcare services were provided to the beneficiary
Confidential communication
(DOS) Date of Service
Referral
Claim
38. 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
Pre-certification
Embezzlement
consent
39. A provision that apples when a person is covered under more than one group medical program
closed panel HMO
(COB) Coordination of Benefits
(PCN) Primary Care Network
(PAC) Pre- Admission Certification
40. Someone who is eligible for or receiving benefits under an insurance policy or plan
attending physician
Beneficiary
attending physician
disclosure
41. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PEC) Pre-existing condition
Privileged information
(DRG's)
transaction
42. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
Resonable Charge
(PCP) Primary Care Physician
Consent form
43. 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
Open Enrollment
ids
electronic media
Individually identifiable health information
44. 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
Supplementary Medical Insurance
(AOB) Assignment of Benefits
electronic media
claim
45. Medical services provided on an outpatient basis
Amblatory Care
health care provider
Confidential communication
Claim
46. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(DOS) Date of Service
Pre-certification
Covered Expenses
confidentiality
47. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Specialist
Experimental Procedures
(PEC) Pre-existing condition
Subscriber
48. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
ee schedule
pcp
transaction
49. 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)
pcp
self-referral
(PAC) Pre- Admission Certification
Consent form
50. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
Beneficiary
Subscriber
premium
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