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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. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
breach of confidential communication
(OOPs) Out of Pocket Costs/Expenses
Experimental Procedures
2. 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
crossover claim
(OOPs) Out of Pocket Costs/Expenses
Protected health information
3. 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
(Non-par) Non-Participating Provider
prepaid plan
referring physician
(DME) Durable Medical Equipment
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
econdary Payer
Experimental Procedures
electronic media
Coordinated Coverage
5. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(OOPs) Out of Pocket Costs/Expenses
Individually identifiable health information
(DCI) Duplicate Coverage Inquiry
Pre-existing Condition Exclusion
6. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
pcp
closed panel HMO
Claim
self-referral
7. Medical services provided on an outpatient basis
authorization form
Amblatory Care
health care provider
etiquette
8. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Open Enrollment
e-health information management
Out of Network (OON)
deductible
9. 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
breach of confidential communication
breach of confidential communication
Pre-certification
10. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Claim
(TPA) Third Party Administrator
open panel HMO
(DME) Durable Medical Equipment
11. 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.
Claim
business associate
medical foundation
consulting physician
12. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
pos
Allowed Expenses
open panel HMO
covered entity
13. 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.
Protected health information
deductible
Supplementary Medical Insurance
IIHI
14. Is the provider who renders a service to a patient
medical foundation
Treating or performing physician
Out of Network (OON)
(DOS) Date of Service
15. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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16. 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)
Privileged information
electronic media
Individually identifiable health information
17. A patient claim is eligible for medicare and medicaid
Specialist
(DOS) Date of Service
crossover claim
subscriber
18. 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
Network
abuse
referring physician
(PCP) Primary Care Physician
19. A monthly fee paid by the insured for specific medical insurance coverage
prepaid plan
(UCR) Usual - Customary and Reasonable
electronic media
premium
20. Medicare's method of paying acute care hospitals for inpatient care
(DRG's)
premium
Deductible
(PPS) Hospital Impatient Prospective Payment System
21. 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.
health care provider
ee schedule
deductible
Medigap Insurance
22. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(PPS) Hospital Impatient Prospective Payment System
subscriber
Individually identifiable health information
transaction
23. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
cash flow
deductible
(UCR) Usual - Customary and Reasonable
AMA
24. A list of the amount to be paid by an insurance company for each procedure service
Beneficiary
ee schedule
Confidential communication
Coordinated Coverage
25. 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
Pre-certification
(UR) Utilization review
Privacy officer
(ERISA) Employee Retirement Income Security Act of 1974
26. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(ERISA) Employee Retirement Income Security Act of 1974
(UR) Utilization review
HIPAA
open panel HMO
27. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
Sub-acute Care
Notice of Privacy Practices
attending physician
pos
28. 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
AMA
Amblatory Care
Supplementary Medical Insurance
Security Rule
29. The amount of actual money available to the medical practice
Subscriber
(DME) Durable Medical Equipment
cash flow
(PPS) Hospital Impatient Prospective Payment System
30. 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
consent
Allowed Expenses
IIHI
31. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
hmo
subscriber
referral
(COB) Coordination of Benefits
32. A provision that apples when a person is covered under more than one group medical program
econdary Payer
consulting physician
open panel HMO
(COB) Coordination of Benefits
33. A health insurance enrollee chooses to see an out of network provider without authorization
Security Rule
Coordinated Coverage
self-referral
Coordinated Coverage
34. A rule - condition - or requirement
Standard
covered entity
state preemption
ethics
35. 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.
Privileged information
Privacy officer
authorization form
claim
36. 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)
(APC) Ambulatory Patient Classifications
cash flow
Consent form
(UR) Utilization review
37. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Preauthorization
open panel HMO
ppo
Pre-certification
38. Medical staff member who is legally responsible for the care and treatment given to a patient.
Specialist
attending physician
(COB) Coordination of Benefits
Network
39. The period of time that payment for Medicare inpatient hospital benefits are available
health care provider
(COB) Coordination of Benefits
benefit period
pcp
40. A structure for classifying outpatient services and procedures for purpose of payment
attending physician
(POS) Point-of Service Plan
(UCR) Usual - Customary and Reasonable
(APC) Ambulatory Patient Classifications
41. The condition of being secluded from the presence or view of others.
breach of confidential communication
privacy
Individually identifiable health information
Covered Expenses
42. A review of the need for inpatient hospital care - completed before the actual admission
health care provider
(TPA) Third Party Administrator
(PAC) Pre- Admission Certification
nonprivileged information
43. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
ethics
Subscriber
(DCI) Duplicate Coverage Inquiry
open panel HMO
44. 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.
breach of confidential communication
business associate
referring physician
Privacy officer
45. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
open panel HMO
IIHI
(OOPs) Out of Pocket Costs/Expenses
consulting physician
46. 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.
preauthorization
Deductible
(Non-par) Non-Participating Provider
state preemption
47. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
hmo
health care provider
Deductible
Pre-certification
48. 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
Coordinated Coverage
preauthorization
referral
Open Enrollment
49. 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
IIHI
Coordinated Coverage
Assignment & Authorization
Preauthorization
50. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
Allowed Expenses
Sub-acute Care
crossover claim