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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.
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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 nonprofit integrated delivery system
transaction
Open Enrollment
medical foundation
Preauthorization
2. Someone who is eligible for or receiving benefits under an insurance policy or plan
health care provider
Consent form
prepaid plan
Beneficiary
3. 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
phantom billing
(ABN) Advance Beneficiary Notice
ee schedule
consulting physician
4. Integrating benefits payable under more than one health insurance.
(DME) Durable Medical Equipment
Coordinated Coverage
Beneficiary
closed panel HMO
5. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Deductible
hmo
complience plan
Privacy officer
6. Customs - rules of conduct - courtesy - and manners of the medical profession
ee schedule
nonprivileged information
authorization form
etiquette
7. 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)
closed panel HMO
Assignment & Authorization
(ABN) Advance Beneficiary Notice
8. 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
consent
econdary Payer
(APC) Ambulatory Patient Classifications
Subscriber
9. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
(PCN) Primary Care Network
Allowed Expenses
pcp
(EPO) Exclusive Provider Organization
10. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Amblatory Care
(DME) Durable Medical Equipment
fraud
preauthorization
11. A monthly fee paid by the insured for specific medical insurance coverage
ids
Maximum Out Of Pocket
premium
Covered Expenses
12. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(EPO) Exclusive Provider Organization
Subscriber
e-health information management
AMA
13. A review of the need for inpatient hospital care - completed before the actual admission
(APC) Ambulatory Patient Classifications
(PAC) Pre- Admission Certification
ids
Supplementary Medical Insurance
14. A monthly fee paid by the insured for specific medical insurance coverage
premium
transaction
Preauthorization
Referral
15. A willful act by an employee of taking possession of an employer's money
Preauthorization
business associate
electronic media
Embezzlement
16. Is a provider who sends the patients for testing or treatment
health care provider
referring physician
Pre-existing Condition Exclusion
(OOPs) Out of Pocket Costs/Expenses
17. A rule - condition - or requirement
Standard
(OOPs) Out of Pocket Costs/Expenses
ppo
(PAC) Pre- Admission Certification
18. 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
clearinghouse
complience
(PCP) Primary Care Physician
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
Sub-acute Care
Preauthorization
benefit period
complience
20. 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
disclosure
clearinghouse
Open Enrollment
privacy
21. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
(PCN) Primary Care Network
Covered Expenses
closed panel HMO
referring physician
22. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
Network
Sub-acute Care
confidentiality
nonprivileged information
23. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(ABN) Advance Beneficiary Notice
Resonable Charge
preauthorization
Referral
24. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(PCP) Primary Care Physician
AMA
Resonable Charge
(DCI) Duplicate Coverage Inquiry
25. A patient claim is eligible for medicare and medicaid
crossover claim
Allowed Expenses
prepaid plan
consulting physician
26. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
ee schedule
phantom billing
Sub-acute Care
27. 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
Maximum Out Of Pocket
Assignment & Authorization
Pre-existing Condition Exclusion
(COB) Coordination of Benefits
28. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
HIPAA
referring physician
Sub-acute Care
29. 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 plan
referring physician
(DOS) Date of Service
30. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
state preemption
(DCI) Duplicate Coverage Inquiry
pcp
preauthorization
31. 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
covered entity
confidentiality
Deductible
open panel HMO
32. 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
benefit period
Covered Expenses
referring physician
Deductible
33. 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
Privileged information
(PCN) Primary Care Network
closed panel HMO
34. 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
Notice of Privacy Practices
(POS) Point-of Service Plan
Preauthorization
(APC) Ambulatory Patient Classifications
35. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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36. The dates of healthcare services were provided to the beneficiary
business associate
Treating or performing physician
(DOS) Date of Service
self-referral
37. 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
(DCI) Duplicate Coverage Inquiry
(COB) Coordination of Benefits
consent
epo
38. Health Information Portability and Accountability Act
(PPS) Hospital Impatient Prospective Payment System
HIPAA
Assignment & Authorization
hmo
39. 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.
Consent form
Sub-acute Care
Privileged information
(ABN) Advance Beneficiary Notice
40. The condition of being secluded from the presence or view of others.
hmo
authorization form
(DOS) Date of Service
privacy
41. The period of time that payment for Medicare inpatient hospital benefits are available
Privileged information
nonprivileged information
benefit period
Open Enrollment
42. 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
e-health information management
Deductible
(COBRA)
Beneficiary
43. Is the provider who renders a service to a patient
self-referral
Supplementary Medical Insurance
ordering physician
Treating or performing physician
44. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
IIHI
ethics
(ABN) Advance Beneficiary Notice
45. 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
(COB) Coordination of Benefits
Maximum Out Of Pocket
Assignment & Authorization
ethics
46. A structure for classifying outpatient services and procedures for purpose of payment
clearinghouse
(APC) Ambulatory Patient Classifications
Protected health information
(DCI) Duplicate Coverage Inquiry
47. A willful act by an employee of taking possession of an employer's money
Out of Network (OON)
epo
Embezzlement
Specialist
48. 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.
ordering physician
Privileged information
Security Rule
(PEC) Pre-existing condition
49. A clinic that is owned by the HMO and the physicians are employees of the HMO
(DRG's)
closed panel HMO
(UCR) Usual - Customary and Reasonable
transaction
50. The maximum amount a plan pays for a covered service
Allowed Expenses
(PCN) Primary Care Network
(DCI) Duplicate Coverage Inquiry
ee schedule
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