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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. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(COBRA)
Maximum Out Of Pocket
complience
consulting physician
2. 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
(PEC) Pre-existing condition
(DRG's)
pcp
3. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(AOB) Assignment of Benefits
(DOS) Date of Service
premium
4. A review of the need for inpatient hospital care - completed before the actual admission
(UCR) Usual - Customary and Reasonable
(PAC) Pre- Admission Certification
referral
Embezzlement
5. The condition of being secluded from the presence or view of others.
privacy
Medigap Insurance
complience plan
Preauthorization
6. 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.
Security Rule
pcp
Privacy officer
(EPO) Exclusive Provider Organization
7. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
consent
(PPS) Hospital Impatient Prospective Payment System
(TPA) Third Party Administrator
Allowed Expenses
8. 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
e-health information management
(APC) Ambulatory Patient Classifications
pcp
9. 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.
Privacy officer
Notice of Privacy Practices
Coordinated Coverage
security officer
10. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Privacy officer
state preemption
(PCN) Primary Care Network
Referral
11. A clinic that is owned by the HMO and the physicians are employees of the HMO
self-referral
covered entity
Supplementary Medical Insurance
closed panel HMO
12. Is the provider who renders a service to a patient
(COB) Coordination of Benefits
Treating or performing physician
e-health information management
open panel HMO
13. Is a provider who sends the patients for testing or treatment
(TPA) Third Party Administrator
referring physician
Resonable Charge
epo
14. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
pos
(DOS) Date of Service
complience plan
Individually identifiable health information
15. 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
(ERISA) Employee Retirement Income Security Act of 1974
(DME) Durable Medical Equipment
Referral
16. 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
Network
(COB) Coordination of Benefits
Assignment & Authorization
Participating Provider
17. Medicare's method of paying acute care hospitals for inpatient care
epo
hmo
AMA
(PPS) Hospital Impatient Prospective Payment System
18. 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.
pos
claim
complience plan
Privileged information
19. 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.
crossover claim
subscriber
(AOB) Assignment of Benefits
Protected health information
20. American Medical Association
premium
Resonable Charge
AMA
(DCI) Duplicate Coverage Inquiry
21. A nonprofit integrated delivery system
medical foundation
(DCI) Duplicate Coverage Inquiry
cash flow
disclosure
22. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
covered entity
(PEC) Pre-existing condition
(ERISA) Employee Retirement Income Security Act of 1974
Resonable Charge
23. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Preauthorization
prepaid plan
closed panel HMO
24. Customs - rules of conduct - courtesy - and manners of the medical profession
ids
etiquette
Privileged information
deductible
25. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
complience plan
confidentiality
Network
preauthorization
26. The dates of healthcare services were provided to the beneficiary
privacy
(DOS) Date of Service
Protected health information
(DCI) Duplicate Coverage Inquiry
27. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
state preemption
(UCR) Usual - Customary and Reasonable
medical foundation
breach of confidential communication
28. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
clearinghouse
Beneficiary
(UCR) Usual - Customary and Reasonable
29. 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
Out of Network (OON)
Pre-existing Condition Exclusion
(Non-par) Non-Participating Provider
30. 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
(PCN) Primary Care Network
Open Enrollment
Coordinated Coverage
(DOS) Date of Service
31. American Medical Association
Medigap Insurance
claim
consulting physician
AMA
32. An organization of provider sites with a contracted relationship that offer services
health care provider
abuse
transaction
ids
33. A nonprofit integrated delivery system
open panel HMO
confidentiality
health care provider
medical foundation
34. 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
preauthorization
Supplementary Medical Insurance
etiquette
health care provider
35. A provision that apples when a person is covered under more than one group medical program
Deductible
(COB) Coordination of Benefits
phantom billing
Pre-existing Condition Exclusion
36. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Participating Provider
(PPS) Hospital Impatient Prospective Payment System
deductible
pcp
37. 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)
(PPS) Hospital Impatient Prospective Payment System
ethics
Supplementary Medical Insurance
Consent form
38. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan
Participating Provider
electronic media
Allowed Expenses
Privacy officer
39. 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
Standard
(ABN) Advance Beneficiary Notice
Preauthorization
(APC) Ambulatory Patient Classifications
40. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Claim
ordering physician
(Non-par) Non-Participating Provider
Specialist
41. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
consulting physician
deductible
breach of confidential communication
premium
42. A privileged communication that may be disclosed only with the patient's permission.
medical foundation
self-referral
subscriber
Confidential communication
43. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Treating or performing physician
nonprivileged information
health care provider
44. 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
(UCR) Usual - Customary and Reasonable
Pre-existing Condition Exclusion
Coordinated Coverage
(ABN) Advance Beneficiary Notice
45. Medical services provided on an outpatient basis
closed panel HMO
Amblatory Care
(EPO) Exclusive Provider Organization
AMA
46. 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
abuse
(PCP) Primary Care Physician
Security Rule
complience plan
47. Is a provider who sends the patients for testing or treatment
referring physician
(COBRA)
claim
ethics
48. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Specialist
(Non-par) Non-Participating Provider
Individually identifiable health information
complience
49. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Sub-acute Care
Open Enrollment
(UR) Utilization review
prepaid plan
50. The amount of actual money available to the medical practice
Maximum Out Of Pocket
HIPAA
closed panel HMO
cash flow