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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. Verbal or written agreement that gives approval to some action - situation - or statement.
(APC) Ambulatory Patient Classifications
ethics
deductible
consent
2. What the insurance company will consider paying for as defined in the contract.
(PCN) Primary Care Network
Specialist
Resonable Charge
Covered Expenses
3. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(APC) Ambulatory Patient Classifications
ordering physician
econdary Payer
Resonable Charge
4. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(DOS) Date of Service
Consent form
Specialist
abuse
5. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
HIPAA
authorization form
Pre-certification
6. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Treating or performing physician
(POS) Point-of Service Plan
clearinghouse
Participating Provider
7. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(Non-par) Non-Participating Provider
Preauthorization
ordering physician
(DOS) Date of Service
8. The period of time that payment for Medicare inpatient hospital benefits are available
claim
referral
benefit period
etiquette
9. 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
complience plan
etiquette
10. 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
phantom billing
ordering physician
covered entity
Sub-acute Care
11. 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
Covered Expenses
Coordinated Coverage
consulting physician
(DME) Durable Medical Equipment
12. 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.
complience
phantom billing
Protected health information
benefit period
13. 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
health care provider
ids
Open Enrollment
(COBRA)
14. A clinic that is owned by the HMO and the physicians are employees of the HMO
Pre-existing Condition Exclusion
electronic media
Resonable Charge
closed panel HMO
15. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
IIHI
Out of Network (OON)
(COBRA)
16. 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
Preauthorization
Individually identifiable health information
pos
health care provider
17. Someone who is eligible for or receiving benefits under an insurance policy or plan
(DOS) Date of Service
breach of confidential communication
pcp
Beneficiary
18. Medical services provided on an outpatient basis
Amblatory Care
authorization form
Subscriber
Participating Provider
19. A review of the need for inpatient hospital care - completed before the actual admission
confidentiality
authorization form
(PAC) Pre- Admission Certification
Assignment & Authorization
20. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
Coordinated Coverage
ppo
Privileged information
disclosure
21. 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
AMA
ee schedule
(TPA) Third Party Administrator
authorization form
22. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(APC) Ambulatory Patient Classifications
deductible
subscriber
Allowed Expenses
23. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
pos
(EPO) Exclusive Provider Organization
(Non-par) Non-Participating Provider
hmo
24. A patient claim is eligible for medicare and medicaid
prepaid plan
ppo
crossover claim
Specialist
25. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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26. Unauthorized release of information
ethics
confidentiality
attending physician
breach of confidential communication
27. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
ordering physician
closed panel HMO
complience plan
Claim
28. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(COBRA)
(TPA) Third Party Administrator
(OOPs) Out of Pocket Costs/Expenses
prepaid plan
29. A review of the need for inpatient hospital care - completed before the actual admission
abuse
e-health information management
confidentiality
(PAC) Pre- Admission Certification
30. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Claim
disclosure
complience plan
medical foundation
31. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Preauthorization
consent
pcp
Amblatory Care
32. An organization of provider sites with a contracted relationship that offer services
(PCN) Primary Care Network
ids
ethics
premium
33. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Participating Provider
premium
pcp
(ERISA) Employee Retirement Income Security Act of 1974
34. An organization of provider sites with a contracted relationship that offer services
covered entity
clearinghouse
ids
prepaid plan
35. 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
prepaid plan
Sub-acute Care
(COBRA)
complience
36. 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
(UCR) Usual - Customary and Reasonable
Out of Network (OON)
disclosure
Individually identifiable health information
37. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(DME) Durable Medical Equipment
phantom billing
clearinghouse
open panel HMO
38. 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.
complience
epo
business associate
consent
39. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(DOS) Date of Service
Medigap Insurance
Individually identifiable health information
crossover claim
40. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
e-health information management
ordering physician
pos
Supplementary Medical Insurance
41. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
ppo
claim
(UR) Utilization review
Claim
42. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
AMA
Amblatory Care
abuse
(OOPs) Out of Pocket Costs/Expenses
43. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Referral
Pre-certification
econdary Payer
Protected health information
44. A monthly fee paid by the insured for specific medical insurance coverage
Pre-existing Condition Exclusion
premium
confidentiality
ordering physician
45. 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.
transaction
state preemption
Consent form
Embezzlement
46. 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
epo
Maximum Out Of Pocket
IIHI
Privileged information
47. 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
(DME) Durable Medical Equipment
Subscriber
AMA
epo
48. A rule - condition - or requirement
Standard
attending physician
subscriber
(DME) Durable Medical Equipment
49. 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.
Referral
security officer
Out of Network (OON)
Embezzlement
50. Unauthorized release of information
breach of confidential communication
state preemption
(COB) Coordination of Benefits
medical foundation