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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. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
crossover claim
(EPO) Exclusive Provider Organization
Security Rule
(DOS) Date of Service
2. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
clearinghouse
(UCR) Usual - Customary and Reasonable
(ERISA) Employee Retirement Income Security Act of 1974
Standard
3. 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
medical foundation
(COBRA)
Pre-existing Condition Exclusion
ordering physician
4. What the insurance company will consider paying for as defined in the contract.
Protected health information
(PCN) Primary Care Network
Covered Expenses
Supplementary Medical Insurance
5. The condition of being secluded from the presence or view of others.
econdary Payer
state preemption
privacy
state preemption
6. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
referral
Privacy officer
Network
Pre-certification
7. 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)
Consent form
closed panel HMO
Preauthorization
(DCI) Duplicate Coverage Inquiry
8. 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
Resonable Charge
Open Enrollment
(ERISA) Employee Retirement Income Security Act of 1974
Maximum Out Of Pocket
9. Standards of conduct generally accepted as a moral guide for behavior.
ethics
medical foundation
Beneficiary
AMA
10. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
Participating Provider
(DOS) Date of Service
Embezzlement
11. Customs - rules of conduct - courtesy - and manners of the medical profession
(ERISA) Employee Retirement Income Security Act of 1974
referral
etiquette
(COBRA)
12. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
(DRG's)
phantom billing
prepaid plan
13. 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
ee schedule
Experimental Procedures
(PPS) Hospital Impatient Prospective Payment System
(AOB) Assignment of Benefits
14. A nonprofit integrated delivery system
Amblatory Care
medical foundation
(UCR) Usual - Customary and Reasonable
Experimental Procedures
15. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
deductible
subscriber
transaction
(APC) Ambulatory Patient Classifications
16. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
(UCR) Usual - Customary and Reasonable
consent
(PPS) Hospital Impatient Prospective Payment System
17. Verbal or written agreement that gives approval to some action - situation - or statement.
Covered Expenses
consent
Assignment & Authorization
medical foundation
18. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(AOB) Assignment of Benefits
open panel HMO
pcp
Pre-certification
19. Is a provider who sends the patients for testing or treatment
referring physician
Deductible
ee schedule
etiquette
20. A willful act by an employee of taking possession of an employer's money
Embezzlement
clearinghouse
complience
(PCP) Primary Care Physician
21. The maximum amount a plan pays for a covered service
HIPAA
Allowed Expenses
Referral
Coordinated Coverage
22. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage
Security Rule
complience plan
(PCP) Primary Care Physician
econdary Payer
23. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Consent form
Out of Network (OON)
Specialist
business associate
24. 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
ppo
referring physician
medical foundation
Experimental Procedures
25. Unauthorized release of information
(PCP) Primary Care Physician
breach of confidential communication
claim
(PCN) Primary Care Network
26. 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
HIPAA
Protected health information
Amblatory Care
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
Deductible
Out of Network (OON)
breach of confidential communication
(PPS) Hospital Impatient Prospective Payment System
28. 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
health care provider
covered entity
ee schedule
(TPA) Third Party Administrator
29. The amount of actual money available to the medical practice
state preemption
pos
crossover claim
cash flow
30. A monthly fee paid by the insured for specific medical insurance coverage
premium
hmo
Notice of Privacy Practices
pos
31. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
confidentiality
(DCI) Duplicate Coverage Inquiry
(POS) Point-of Service Plan
(AOB) Assignment of Benefits
32. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
crossover claim
Claim
IIHI
fraud
33. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(ERISA) Employee Retirement Income Security Act of 1974
Referral
claim
cash flow
34. 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
fraud
(COBRA)
prepaid plan
35. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
Out of Network (OON)
Network
Privacy officer
abuse
36. A rule - condition - or requirement
Standard
complience
prepaid plan
business associate
37. Customs - rules of conduct - courtesy - and manners of the medical profession
Allowed Expenses
(PCN) Primary Care Network
(DOS) Date of Service
etiquette
38. 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
security officer
Deductible
Privacy officer
clearinghouse
39. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Sub-acute Care
(UR) Utilization review
deductible
40. A monthly fee paid by the insured for specific medical insurance coverage
referral
confidentiality
premium
(UCR) Usual - Customary and Reasonable
41. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
privacy
(POS) Point-of Service Plan
(UR) Utilization review
Specialist
42. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
ordering physician
consent
authorization form
43. 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
ee schedule
HIPAA
(PCP) Primary Care Physician
Supplementary Medical Insurance
44. Is the provider who renders a service to a patient
Protected health information
Sub-acute Care
Treating or performing physician
consulting physician
45. 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
phantom billing
Preauthorization
clearinghouse
46. The condition of being secluded from the presence or view of others.
Assignment & Authorization
fraud
Privacy officer
privacy
47. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
phantom billing
Claim
fraud
48. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(COBRA)
Treating or performing physician
subscriber
Privileged information
49. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Pre-certification
confidentiality
Claim
deductible
50. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
Coordinated Coverage
AMA
Out of Network (OON)
econdary Payer