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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. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Privacy officer
phantom billing
preauthorization
(COBRA)
2. A rule - condition - or requirement
confidentiality
Consent form
(PEC) Pre-existing condition
Standard
3. Standards of conduct generally accepted as a moral guide for behavior.
claim
Claim
ethics
covered entity
4. Unauthorized release of information
hmo
breach of confidential communication
medical foundation
Network
5. Medicare's method of paying acute care hospitals for inpatient care
phantom billing
(PPS) Hospital Impatient Prospective Payment System
Preauthorization
Embezzlement
6. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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7. 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
ordering physician
Protected health information
epo
8. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Medigap Insurance
covered entity
confidentiality
9. 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
Protected health information
(DRG's)
Deductible
(ABN) Advance Beneficiary Notice
10. Someone who is eligible for or receiving benefits under an insurance policy or plan
health care provider
Beneficiary
Notice of Privacy Practices
(Non-par) Non-Participating Provider
11. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
clearinghouse
Treating or performing physician
abuse
Embezzlement
12. 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
disclosure
Security Rule
ids
closed panel HMO
13. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Subscriber
covered entity
disclosure
14. 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
(PCP) Primary Care Physician
closed panel HMO
open panel HMO
authorization form
15. Medical staff member who is legally responsible for the care and treatment given to a patient.
Allowed Expenses
security officer
Specialist
attending physician
16. 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
subscriber
Out of Network (OON)
referring physician
17. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Coordinated Coverage
Medigap Insurance
(APC) Ambulatory Patient Classifications
consulting physician
18. 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)
ids
subscriber
privacy
19. 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
Treating or performing physician
referring physician
electronic media
Sub-acute Care
20. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare
(ABN) Advance Beneficiary Notice
(Non-par) Non-Participating Provider
Specialist
transaction
21. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
Amblatory Care
(ERISA) Employee Retirement Income Security Act of 1974
prepaid plan
(UCR) Usual - Customary and Reasonable
22. The maximum amount a plan pays for a covered service
(APC) Ambulatory Patient Classifications
self-referral
Allowed Expenses
Notice of Privacy Practices
23. 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)
Standard
self-referral
Embezzlement
Consent form
24. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(POS) Point-of Service Plan
Resonable Charge
pcp
(UR) Utilization review
25. Medical services provided on an outpatient basis
Pre-existing Condition Exclusion
Individually identifiable health information
Amblatory Care
e-health information management
26. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
etiquette
transaction
(TPA) Third Party Administrator
(UR) Utilization review
27. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Security Rule
abuse
Deductible
(COBRA)
28. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
(PEC) Pre-existing condition
Treating or performing physician
Experimental Procedures
29. 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 Rule
ethics
phantom billing
(PAC) Pre- Admission Certification
30. 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
(PCP) Primary Care Physician
consulting physician
abuse
(DME) Durable Medical Equipment
31. American Medical Association
preauthorization
AMA
medical foundation
Standard
32. The period of time that payment for Medicare inpatient hospital benefits are available
(COBRA)
(UCR) Usual - Customary and Reasonable
Standard
benefit period
33. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Individually identifiable health information
confidentiality
(PEC) Pre-existing condition
consent
34. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
pcp
Supplementary Medical Insurance
Privacy officer
(DCI) Duplicate Coverage Inquiry
35. 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
Allowed Expenses
Maximum Out Of Pocket
(EPO) Exclusive Provider Organization
Protected health information
36. Medical staff member who is legally responsible for the care and treatment given to a patient.
(DME) Durable Medical Equipment
Protected health information
electronic media
attending physician
37. 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
ethics
Supplementary Medical Insurance
(DCI) Duplicate Coverage Inquiry
Privileged information
38. Billing for services not performed
prepaid plan
phantom billing
covered entity
clearinghouse
39. An organization of provider sites with a contracted relationship that offer services
(TPA) Third Party Administrator
ids
Pre-existing Condition Exclusion
(POS) Point-of Service Plan
40. 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.
state preemption
(PCN) Primary Care Network
Coordinated Coverage
(APC) Ambulatory Patient Classifications
41. 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
Pre-existing Condition Exclusion
Medigap Insurance
(DRG's)
42. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Protected health information
electronic media
clearinghouse
business associate
43. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Privacy officer
Pre-certification
Individually identifiable health information
(PEC) Pre-existing condition
44. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
breach of confidential communication
(AOB) Assignment of Benefits
open panel HMO
confidentiality
45. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Open Enrollment
Deductible
(PCN) Primary Care Network
46. 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.
referring physician
econdary Payer
Privileged information
transaction
47. What the insurance company will consider paying for as defined in the contract.
Specialist
Covered Expenses
Consent form
(PAC) Pre- Admission Certification
48. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Protected health information
Individually identifiable health information
Specialist
referral
49. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
Beneficiary
pcp
(PCP) Primary Care Physician
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.
fraud
Security Rule
health care provider
(PAC) Pre- Admission Certification