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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. A willful act by an employee of taking possession of an employer's money
Specialist
Embezzlement
Privacy officer
(DOS) Date of Service
2. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Subscriber
Referral
(UR) Utilization review
(OOPs) Out of Pocket Costs/Expenses
3. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
ppo
(OOPs) Out of Pocket Costs/Expenses
IIHI
ethics
4. Standards of conduct generally accepted as a moral guide for behavior.
Allowed Expenses
security officer
crossover claim
ethics
5. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Referral
(TPA) Third Party Administrator
Experimental Procedures
phantom billing
6. 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
(PEC) Pre-existing condition
closed panel HMO
Notice of Privacy Practices
covered entity
7. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
state preemption
disclosure
ethics
business associate
8. The dates of healthcare services were provided to the beneficiary
deductible
Deductible
Specialist
(DOS) Date of Service
9. A monthly fee paid by the insured for specific medical insurance coverage
Network
(POS) Point-of Service Plan
Amblatory Care
premium
10. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
crossover claim
Network
medical foundation
11. Individually identifiable health information
medical foundation
referring physician
electronic media
IIHI
12. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(PPS) Hospital Impatient Prospective Payment System
(DME) Durable Medical Equipment
deductible
ee schedule
13. A list of the amount to be paid by an insurance company for each procedure service
Consent form
ee schedule
self-referral
ordering physician
14. 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
Supplementary Medical Insurance
Sub-acute Care
(OOPs) Out of Pocket Costs/Expenses
ppo
15. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
(AOB) Assignment of Benefits
Open Enrollment
crossover claim
16. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Allowed Expenses
attending physician
Individually identifiable health information
benefit period
17. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(OOPs) Out of Pocket Costs/Expenses
e-health information management
Individually identifiable health information
crossover claim
18. 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
etiquette
Experimental Procedures
(UR) Utilization review
(PCN) Primary Care Network
19. 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
self-referral
nonprivileged information
privacy
(DOS) Date of Service
20. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
phantom billing
Embezzlement
Preauthorization
21. 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
preauthorization
clearinghouse
Individually identifiable health information
(PCN) Primary Care Network
22. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
fraud
(DCI) Duplicate Coverage Inquiry
security officer
Medigap Insurance
23. 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
crossover claim
(ABN) Advance Beneficiary Notice
ids
(APC) Ambulatory Patient Classifications
24. 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.
attending physician
ids
privacy
Protected health information
25. The period of time that payment for Medicare inpatient hospital benefits are available
authorization form
benefit period
claim
complience plan
26. 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
Covered Expenses
consent
(AOB) Assignment of Benefits
27. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
ids
(DCI) Duplicate Coverage Inquiry
epo
Out of Network (OON)
28. Is the provider who renders a service to a patient
Treating or performing physician
nonprivileged information
Notice of Privacy Practices
Individually identifiable health information
29. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Maximum Out Of Pocket
epo
(PEC) Pre-existing condition
ethics
30. 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
(AOB) Assignment of Benefits
(PPS) Hospital Impatient Prospective Payment System
epo
(APC) Ambulatory Patient Classifications
31. A nonprofit integrated delivery system
(DOS) Date of Service
benefit period
medical foundation
attending physician
32. 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
fraud
econdary Payer
self-referral
33. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
health care provider
hmo
(AOB) Assignment of Benefits
transaction
34. 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
transaction
hmo
Notice of Privacy Practices
35. A rule - condition - or requirement
etiquette
Standard
(PAC) Pre- Admission Certification
Beneficiary
36. 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.
Network
ee schedule
state preemption
Privacy officer
37. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(OOPs) Out of Pocket Costs/Expenses
Specialist
(EPO) Exclusive Provider Organization
(Non-par) Non-Participating Provider
38. 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
benefit period
Assignment & Authorization
Privacy officer
econdary Payer
39. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(AOB) Assignment of Benefits
Claim
Referral
preauthorization
40. Integrating benefits payable under more than one health insurance.
(UCR) Usual - Customary and Reasonable
(Non-par) Non-Participating Provider
Coordinated Coverage
(PCN) Primary Care Network
41. 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
Maximum Out Of Pocket
Individually identifiable health information
(COBRA)
authorization form
42. 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.
(PEC) Pre-existing condition
consulting physician
confidentiality
security officer
43. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(ABN) Advance Beneficiary Notice
claim
fraud
complience plan
44. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(PCN) Primary Care Network
breach of confidential communication
breach of confidential communication
Medigap Insurance
45. 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
AMA
(ABN) Advance Beneficiary Notice
self-referral
46. A review of the need for inpatient hospital care - completed before the actual admission
(EPO) Exclusive Provider Organization
(PAC) Pre- Admission Certification
Participating Provider
nonprivileged information
47. An intentional misrepresentation of the facts to deceive or mislead another.
business associate
Consent form
fraud
Maximum Out Of Pocket
48. A patient claim is eligible for medicare and medicaid
IIHI
crossover claim
referral
(Non-par) Non-Participating Provider
49. 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
breach of confidential communication
Pre-certification
Preauthorization
claim
50. 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
e-health information management
Experimental Procedures
medical foundation
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