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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. 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
pos
(DME) Durable Medical Equipment
clearinghouse
Beneficiary
2. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
business associate
Privileged information
fraud
pcp
3. Individually identifiable health information
(PCP) Primary Care Physician
Amblatory Care
IIHI
Treating or performing physician
4. 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
referring physician
(DOS) Date of Service
Notice of Privacy Practices
(ERISA) Employee Retirement Income Security Act of 1974
5. What the insurance company will consider paying for as defined in the contract.
Participating Provider
Covered Expenses
(PPS) Hospital Impatient Prospective Payment System
pos
6. 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
Preauthorization
ids
pcp
7. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
consent
premium
clearinghouse
Beneficiary
8. 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
Assignment & Authorization
Pre-certification
(APC) Ambulatory Patient Classifications
9. 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.
econdary Payer
health care provider
Notice of Privacy Practices
(AOB) Assignment of Benefits
10. The period of time that payment for Medicare inpatient hospital benefits are available
complience
security officer
benefit period
Maximum Out Of Pocket
11. 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
ppo
authorization form
nonprivileged information
(EPO) Exclusive Provider Organization
12. A monthly fee paid by the insured for specific medical insurance coverage
benefit period
subscriber
premium
Supplementary Medical Insurance
13. A patient claim is eligible for medicare and medicaid
crossover claim
referring physician
Assignment & Authorization
covered entity
14. A clinic that is owned by the HMO and the physicians are employees of the HMO
Assignment & Authorization
prepaid plan
covered entity
closed panel HMO
15. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Amblatory Care
ethics
disclosure
self-referral
16. The condition of being secluded from the presence or view of others.
complience
privacy
referral
HIPAA
17. Medicare's method of paying acute care hospitals for inpatient care
Embezzlement
(PPS) Hospital Impatient Prospective Payment System
ethics
subscriber
18. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
Coordinated Coverage
covered entity
hmo
19. Approval or consent by a primary physician for patient referral to ancillary services and specialists
claim
(PEC) Pre-existing condition
Referral
Amblatory Care
20. Verbal or written agreement that gives approval to some action - situation - or statement.
breach of confidential communication
consent
Individually identifiable health information
subscriber
21. 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
Subscriber
(DCI) Duplicate Coverage Inquiry
ppo
Amblatory Care
22. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
(UR) Utilization review
attending physician
(APC) Ambulatory Patient Classifications
23. The condition of being secluded from the presence or view of others.
Referral
authorization form
privacy
claim
24. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Individually identifiable health information
(EPO) Exclusive Provider Organization
Protected health information
25. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
phantom billing
confidentiality
open panel HMO
26. 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
nonprivileged information
HIPAA
crossover claim
self-referral
27. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
covered entity
Network
Open Enrollment
(UR) Utilization review
28. The transmission of information between two parties to carry out financial or administrative activities related to health care.
medical foundation
transaction
Supplementary Medical Insurance
Subscriber
29. Medical services provided on an outpatient basis
breach of confidential communication
consent
(COBRA)
Amblatory Care
30. A willful act by an employee of taking possession of an employer's money
medical foundation
pcp
(PCP) Primary Care Physician
Embezzlement
31. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
complience plan
Subscriber
health care provider
(DOS) Date of Service
32. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Allowed Expenses
referral
Pre-certification
deductible
33. The amount of actual money available to the medical practice
AMA
(DME) Durable Medical Equipment
abuse
cash flow
34. 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)
IIHI
closed panel HMO
Amblatory Care
Consent form
35. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
pos
(PAC) Pre- Admission Certification
Referral
confidentiality
36. 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
Subscriber
(PAC) Pre- Admission Certification
Allowed Expenses
epo
37. An organization of provider sites with a contracted relationship that offer services
confidentiality
deductible
crossover claim
ids
38. Medical staff member who is legally responsible for the care and treatment given to a patient.
Coordinated Coverage
Pre-certification
attending physician
referral
39. Is the provider who renders a service to a patient
(PPS) Hospital Impatient Prospective Payment System
nonprivileged information
(Non-par) Non-Participating Provider
Treating or performing physician
40. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
epo
abuse
confidentiality
(PCN) Primary Care Network
41. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(UCR) Usual - Customary and Reasonable
Medigap Insurance
Amblatory Care
covered entity
42. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
(DCI) Duplicate Coverage Inquiry
Medigap Insurance
Pre-existing Condition Exclusion
43. 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
transaction
(COBRA)
attending physician
breach of confidential communication
44. 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
(ABN) Advance Beneficiary Notice
Assignment & Authorization
Supplementary Medical Insurance
fraud
45. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
transaction
hmo
(UCR) Usual - Customary and Reasonable
Covered Expenses
46. 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
Out of Network (OON)
open panel HMO
ppo
Open Enrollment
47. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Privileged information
(PPS) Hospital Impatient Prospective Payment System
disclosure
Treating or performing physician
48. A nonprofit integrated delivery system
medical foundation
AMA
clearinghouse
self-referral
49. A privileged communication that may be disclosed only with the patient's permission.
econdary Payer
Covered Expenses
AMA
Confidential communication
50. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PAC) Pre- Admission Certification
abuse
complience
Referral