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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. A willful act by an employee of taking possession of an employer's money
hmo
Embezzlement
Medigap Insurance
claim
2. The amount of actual money available to the medical practice
benefit period
cash flow
(EPO) Exclusive Provider Organization
pos
3. 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
(UR) Utilization review
(AOB) Assignment of Benefits
Sub-acute Care
Embezzlement
4. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Coordinated Coverage
Confidential communication
Confidential communication
5. 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
e-health information management
(Non-par) Non-Participating Provider
Amblatory Care
open panel HMO
6. 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.
Covered Expenses
(PCN) Primary Care Network
complience
business associate
7. 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.
premium
Treating or performing physician
business associate
security officer
8. Unauthorized release of information
Treating or performing physician
breach of confidential communication
fraud
Assignment & Authorization
9. 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
(UR) Utilization review
authorization form
(Non-par) Non-Participating Provider
nonprivileged information
10. A monthly fee paid by the insured for specific medical insurance coverage
Out of Network (OON)
disclosure
premium
ordering physician
11. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
disclosure
prepaid plan
(EPO) Exclusive Provider Organization
(PPS) Hospital Impatient Prospective Payment System
12. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
business associate
hmo
(DCI) Duplicate Coverage Inquiry
Preauthorization
13. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Confidential communication
Consent form
Covered Expenses
14. 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-existing Condition Exclusion
(DOS) Date of Service
(PCP) Primary Care Physician
15. 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
Referral
(UCR) Usual - Customary and Reasonable
abuse
Deductible
16. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Medigap Insurance
breach of confidential communication
clearinghouse
pcp
17. Health Information Portability and Accountability Act
HIPAA
prepaid plan
security officer
state preemption
18. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
confidentiality
pcp
Sub-acute Care
19. The maximum amount a plan pays for a covered service
Allowed Expenses
disclosure
Consent form
(PCP) Primary Care Physician
20. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Pre-certification
Experimental Procedures
(EPO) Exclusive Provider Organization
21. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Pre-existing Condition Exclusion
(PPS) Hospital Impatient Prospective Payment System
abuse
(COB) Coordination of Benefits
22. 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
(OOPs) Out of Pocket Costs/Expenses
benefit period
prepaid plan
23. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
fraud
covered entity
Standard
electronic media
24. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
prepaid plan
(ABN) Advance Beneficiary Notice
complience
Embezzlement
25. An organization of provider sites with a contracted relationship that offer services
cash flow
ids
transaction
state preemption
26. An intentional misrepresentation of the facts to deceive or mislead another.
ethics
Maximum Out Of Pocket
Maximum Out Of Pocket
fraud
27. 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
complience plan
Experimental Procedures
abuse
ee schedule
28. 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
Specialist
hmo
Supplementary Medical Insurance
health care provider
29. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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30. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
AMA
confidentiality
deductible
(COB) Coordination of Benefits
31. A provision that apples when a person is covered under more than one group medical program
Resonable Charge
Individually identifiable health information
epo
(COB) Coordination of Benefits
32. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Medigap Insurance
Claim
cash flow
Referral
33. 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
(POS) Point-of Service Plan
state preemption
Assignment & Authorization
(OOPs) Out of Pocket Costs/Expenses
34. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
benefit period
Experimental Procedures
complience
35. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Open Enrollment
confidentiality
(DME) Durable Medical Equipment
36. The maximum amount a plan pays for a covered service
Allowed Expenses
pos
Notice of Privacy Practices
(OOPs) Out of Pocket Costs/Expenses
37. A nonprofit integrated delivery system
medical foundation
electronic media
confidentiality
Medigap Insurance
38. 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
HIPAA
referring physician
(TPA) Third Party Administrator
pos
39. 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
Privileged information
Out of Network (OON)
hmo
privacy
40. Unauthorized release of information
Covered Expenses
closed panel HMO
breach of confidential communication
deductible
41. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Pre-existing Condition Exclusion
Allowed Expenses
(OOPs) Out of Pocket Costs/Expenses
privacy
42. American Medical Association
Allowed Expenses
attending physician
hmo
AMA
43. 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
econdary Payer
(AOB) Assignment of Benefits
Preauthorization
referring physician
44. 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
Experimental Procedures
transaction
Pre-existing Condition Exclusion
ethics
45. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
IIHI
Experimental Procedures
Resonable Charge
Individually identifiable health information
46. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
pos
Notice of Privacy Practices
health care provider
disclosure
47. A review of the need for inpatient hospital care - completed before the actual admission
etiquette
transaction
(PAC) Pre- Admission Certification
(ABN) Advance Beneficiary Notice
48. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
crossover claim
Claim
(ERISA) Employee Retirement Income Security Act of 1974
49. Is a provider who sends the patients for testing or treatment
referring physician
(APC) Ambulatory Patient Classifications
Subscriber
nonprivileged information
50. An organization of provider sites with a contracted relationship that offer services
(PEC) Pre-existing condition
(UCR) Usual - Customary and Reasonable
ids
(PCP) Primary Care Physician