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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. 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
(PEC) Pre-existing condition
(OOPs) Out of Pocket Costs/Expenses
Maximum Out Of Pocket
etiquette
2. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Privacy officer
Network
pcp
Confidential communication
3. 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.
consulting physician
business associate
Amblatory Care
Medigap Insurance
4. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Embezzlement
Individually identifiable health information
deductible
Embezzlement
5. A health insurance enrollee chooses to see an out of network provider without authorization
(APC) Ambulatory Patient Classifications
pcp
hmo
self-referral
6. 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
referring physician
Open Enrollment
nonprivileged information
health care provider
7. 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
referral
ppo
Experimental Procedures
ppo
8. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(DOS) Date of Service
AMA
Participating Provider
(PEC) Pre-existing condition
9. Health Information Portability and Accountability Act
closed panel HMO
security officer
HIPAA
Subscriber
10. Medicare's method of paying acute care hospitals for inpatient care
(TPA) Third Party Administrator
(PPS) Hospital Impatient Prospective Payment System
(DCI) Duplicate Coverage Inquiry
Security Rule
11. 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
Treating or performing physician
(DME) Durable Medical Equipment
(ERISA) Employee Retirement Income Security Act of 1974
Assignment & Authorization
12. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
phantom billing
electronic media
business associate
self-referral
13. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
Notice of Privacy Practices
Treating or performing physician
nonprivileged information
14. Someone who is eligible for or receiving benefits under an insurance policy or plan
Supplementary Medical Insurance
epo
prepaid plan
Beneficiary
15. 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
Deductible
(Non-par) Non-Participating Provider
authorization form
Embezzlement
16. A willful act by an employee of taking possession of an employer's money
clearinghouse
Embezzlement
epo
(APC) Ambulatory Patient Classifications
17. 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.
clearinghouse
hmo
(POS) Point-of Service Plan
Protected health information
18. 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
Protected health information
business associate
(ABN) Advance Beneficiary Notice
medical foundation
19. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
medical foundation
IIHI
consulting physician
(UCR) Usual - Customary and Reasonable
20. A list of the amount to be paid by an insurance company for each procedure service
Confidential communication
(ABN) Advance Beneficiary Notice
ee schedule
Deductible
21. The amount of actual money available to the medical practice
Sub-acute Care
cash flow
business associate
HIPAA
22. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(ERISA) Employee Retirement Income Security Act of 1974
(PCP) Primary Care Physician
subscriber
(DRG's)
23. What the insurance company will consider paying for as defined in the contract.
disclosure
(COBRA)
Privileged information
Covered Expenses
24. A review of the need for inpatient hospital care - completed before the actual admission
(AOB) Assignment of Benefits
Claim
Medigap Insurance
(PAC) Pre- Admission Certification
25. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
complience
Amblatory Care
Notice of Privacy Practices
26. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
Individually identifiable health information
ordering physician
pos
27. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
Pre-existing Condition Exclusion
nonprivileged information
Medigap Insurance
28. 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
(Non-par) Non-Participating Provider
authorization form
prepaid plan
Pre-certification
29. 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
complience plan
nonprivileged information
AMA
Assignment & Authorization
30. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
epo
(AOB) Assignment of Benefits
Out of Network (OON)
(DCI) Duplicate Coverage Inquiry
31. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
cash flow
consent
clearinghouse
subscriber
32. 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
Notice of Privacy Practices
(AOB) Assignment of Benefits
(PCN) Primary Care Network
covered entity
33. 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
(DOS) Date of Service
Notice of Privacy Practices
(AOB) Assignment of Benefits
(POS) Point-of Service Plan
34. An intentional misrepresentation of the facts to deceive or mislead another.
complience
referring physician
medical foundation
fraud
35. The dates of healthcare services were provided to the beneficiary
preauthorization
(DOS) Date of Service
(DME) Durable Medical Equipment
(PEC) Pre-existing condition
36. 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
referral
phantom billing
pos
self-referral
37. 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
Allowed Expenses
Sub-acute Care
abuse
authorization form
38. 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
econdary Payer
transaction
deductible
preauthorization
39. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(DRG's)
ee schedule
(EPO) Exclusive Provider Organization
Privacy officer
40. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
subscriber
phantom billing
privacy
41. 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.
(COBRA)
health care provider
Embezzlement
ethics
42. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
AMA
ee schedule
e-health information management
attending physician
43. 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
(POS) Point-of Service Plan
fraud
Pre-certification
Subscriber
44. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Medigap Insurance
Claim
ordering physician
Deductible
45. Billing for services not performed
(PPS) Hospital Impatient Prospective Payment System
phantom billing
crossover claim
covered entity
46. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
disclosure
Allowed Expenses
(TPA) Third Party Administrator
ids
47. A provision that apples when a person is covered under more than one group medical program
(COBRA)
(COB) Coordination of Benefits
(APC) Ambulatory Patient Classifications
Medigap Insurance
48. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
closed panel HMO
consent
Deductible
49. 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
Open Enrollment
covered entity
preauthorization
Sub-acute Care
50. 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
(ABN) Advance Beneficiary Notice
closed panel HMO
epo
(UCR) Usual - Customary and Reasonable