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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. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Coordinated Coverage
transaction
(UR) Utilization review
preauthorization
2. A monthly fee paid by the insured for specific medical insurance coverage
Individually identifiable health information
premium
(ERISA) Employee Retirement Income Security Act of 1974
epo
3. Standards of conduct generally accepted as a moral guide for behavior.
Network
ethics
(COB) Coordination of Benefits
Notice of Privacy Practices
4. 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
consent
Experimental Procedures
(TPA) Third Party Administrator
breach of confidential communication
5. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Pre-existing Condition Exclusion
Supplementary Medical Insurance
claim
fraud
6. Billing for services not performed
premium
Standard
phantom billing
covered entity
7. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Participating Provider
(DCI) Duplicate Coverage Inquiry
open panel HMO
IIHI
8. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
ordering physician
preauthorization
(DRG's)
(EPO) Exclusive Provider Organization
9. 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
Supplementary Medical Insurance
(PEC) Pre-existing condition
Experimental Procedures
pos
10. 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
(PCN) Primary Care Network
Embezzlement
abuse
11. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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12. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(PPS) Hospital Impatient Prospective Payment System
(COB) Coordination of Benefits
pcp
Specialist
13. 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
(APC) Ambulatory Patient Classifications
Preauthorization
deductible
ee schedule
14. 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
Maximum Out Of Pocket
(PCN) Primary Care Network
benefit period
Specialist
15. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
consulting physician
(PCP) Primary Care Physician
clearinghouse
subscriber
16. 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
(DME) Durable Medical Equipment
cash flow
Sub-acute Care
authorization form
17. Individually identifiable health information
business associate
prepaid plan
IIHI
Preauthorization
18. A health insurance enrollee chooses to see an out of network provider without authorization
IIHI
fraud
e-health information management
self-referral
19. 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
(ERISA) Employee Retirement Income Security Act of 1974
closed panel HMO
Deductible
health care provider
20. 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
prepaid plan
self-referral
(Non-par) Non-Participating Provider
econdary Payer
21. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
nonprivileged information
security officer
Out of Network (OON)
(UCR) Usual - Customary and Reasonable
22. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
Resonable Charge
epo
subscriber
Security Rule
23. A review of the need for inpatient hospital care - completed before the actual admission
etiquette
Medigap Insurance
Security Rule
(PAC) Pre- Admission Certification
24. 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
(DME) Durable Medical Equipment
subscriber
fraud
consent
25. 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
Privacy officer
ethics
(OOPs) Out of Pocket Costs/Expenses
Maximum Out Of Pocket
26. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Network
Claim
breach of confidential communication
27. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
transaction
referring physician
Network
28. A health insurance enrollee chooses to see an out of network provider without authorization
prepaid plan
abuse
Protected health information
self-referral
29. 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.
(PAC) Pre- Admission Certification
health care provider
disclosure
Covered Expenses
30. American Medical Association
(PPS) Hospital Impatient Prospective Payment System
referral
authorization form
AMA
31. A patient claim is eligible for medicare and medicaid
(APC) Ambulatory Patient Classifications
state preemption
crossover claim
Treating or performing physician
32. An intentional misrepresentation of the facts to deceive or mislead another.
claim
Experimental Procedures
fraud
breach of confidential communication
33. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(TPA) Third Party Administrator
Pre-certification
referral
(OOPs) Out of Pocket Costs/Expenses
34. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
(TPA) Third Party Administrator
(ERISA) Employee Retirement Income Security Act of 1974
Treating or performing physician
35. A willful act by an employee of taking possession of an employer's money
pcp
Embezzlement
Experimental Procedures
consulting physician
36. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
security officer
(TPA) Third Party Administrator
ordering physician
37. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
(DME) Durable Medical Equipment
Subscriber
(OOPs) Out of Pocket Costs/Expenses
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.
Beneficiary
business associate
crossover claim
Consent form
39. 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
pos
fraud
electronic media
econdary Payer
40. 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
Open Enrollment
business associate
Supplementary Medical Insurance
premium
41. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.
claim
prepaid plan
Notice of Privacy Practices
medical foundation
42. A rule - condition - or requirement
(EPO) Exclusive Provider Organization
Specialist
closed panel HMO
Standard
43. What the insurance company will consider paying for as defined in the contract.
(DME) Durable Medical Equipment
ppo
ethics
Covered Expenses
44. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Participating Provider
abuse
covered entity
(OOPs) Out of Pocket Costs/Expenses
45. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(UR) Utilization review
confidentiality
hmo
attending physician
46. Is a provider who sends the patients for testing or treatment
ids
referring physician
open panel HMO
Pre-existing Condition Exclusion
47. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
security officer
Embezzlement
(UCR) Usual - Customary and Reasonable
Participating Provider
48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
preauthorization
Treating or performing physician
(Non-par) Non-Participating Provider
49. A list of the amount to be paid by an insurance company for each procedure service
IIHI
ee schedule
disclosure
state preemption
50. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(COB) Coordination of Benefits
Allowed Expenses
privacy
subscriber