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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. 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
Supplementary Medical Insurance
preauthorization
security officer
Sub-acute Care
2. 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
Pre-existing Condition Exclusion
Medigap Insurance
Coordinated Coverage
(DME) Durable Medical Equipment
3. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
attending physician
(ERISA) Employee Retirement Income Security Act of 1974
Supplementary Medical Insurance
(EPO) Exclusive Provider Organization
4. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Treating or performing physician
Claim
Open Enrollment
5. 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
Specialist
electronic media
(COB) Coordination of Benefits
(ABN) Advance Beneficiary Notice
6. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
prepaid plan
Maximum Out Of Pocket
confidentiality
breach of confidential communication
7. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
premium
epo
(POS) Point-of Service Plan
8. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage
(TPA) Third Party Administrator
ethics
(PCP) Primary Care Physician
(UCR) Usual - Customary and Reasonable
9. 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
Assignment & Authorization
Resonable Charge
econdary Payer
Medigap Insurance
10. A structure for classifying outpatient services and procedures for purpose of payment
(COBRA)
ordering physician
(APC) Ambulatory Patient Classifications
abuse
11. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Coordinated Coverage
complience plan
(PAC) Pre- Admission Certification
(TPA) Third Party Administrator
12. 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
(OOPs) Out of Pocket Costs/Expenses
Referral
complience
(ERISA) Employee Retirement Income Security Act of 1974
13. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
Covered Expenses
AMA
ethics
14. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
Out of Network (OON)
disclosure
abuse
Supplementary Medical Insurance
15. A monthly fee paid by the insured for specific medical insurance coverage
Beneficiary
Participating Provider
premium
Consent form
16. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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17. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
closed panel HMO
etiquette
(COBRA)
18. A rule - condition - or requirement
Assignment & Authorization
Standard
(ERISA) Employee Retirement Income Security Act of 1974
security officer
19. Billing for services not performed
ppo
phantom billing
Privacy officer
clearinghouse
20. 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
Coordinated Coverage
Privileged information
confidentiality
(COBRA)
21. 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
Preauthorization
(PPS) Hospital Impatient Prospective Payment System
crossover claim
premium
22. 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
preauthorization
cash flow
ee schedule
23. 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
authorization form
hmo
Protected health information
Covered Expenses
24. The condition of being secluded from the presence or view of others.
privacy
(DOS) Date of Service
business associate
consulting physician
25. 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
Open Enrollment
Participating Provider
Referral
complience plan
26. The amount of actual money available to the medical practice
Participating Provider
Confidential communication
nonprivileged information
cash flow
27. 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.
pcp
Privileged information
consent
fraud
28. A review of the need for inpatient hospital care - completed before the actual admission
consulting physician
self-referral
(PAC) Pre- Admission Certification
pos
29. A patient claim is eligible for medicare and medicaid
(PCP) Primary Care Physician
crossover claim
benefit period
Privacy officer
30. 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
covered entity
Preauthorization
Specialist
disclosure
31. 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
Referral
complience plan
covered entity
32. 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
ids
Claim
closed panel HMO
(PCN) Primary Care Network
33. 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)
AMA
breach of confidential communication
Consent form
Out of Network (OON)
34. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
ppo
(DOS) Date of Service
Referral
35. 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
(EPO) Exclusive Provider Organization
Pre-certification
Resonable Charge
Maximum Out Of Pocket
36. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
pos
(PCP) Primary Care Physician
confidentiality
deductible
37. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Protected health information
Pre-certification
(OOPs) Out of Pocket Costs/Expenses
state preemption
38. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
consent
(UR) Utilization review
(POS) Point-of Service Plan
Network
39. 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
AMA
ids
Assignment & Authorization
(AOB) Assignment of Benefits
40. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
Embezzlement
prepaid plan
consulting physician
consent
41. An organization of provider sites with a contracted relationship that offer services
ee schedule
ids
Embezzlement
ordering physician
42. 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.
Notice of Privacy Practices
complience
business associate
open panel HMO
43. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
Referral
attending physician
electronic media
44. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
preauthorization
security officer
etiquette
(OOPs) Out of Pocket Costs/Expenses
45. 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.
(UCR) Usual - Customary and Reasonable
Beneficiary
clearinghouse
Protected health information
46. 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
Beneficiary
premium
state preemption
(AOB) Assignment of Benefits
47. 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
e-health information management
Network
Referral
48. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(DRG's)
Resonable Charge
Pre-certification
Beneficiary
49. 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
preauthorization
e-health information management
Deductible
Experimental Procedures
50. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage
consent
(PCP) Primary Care Physician
open panel HMO
Covered Expenses