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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. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
closed panel HMO
(EPO) Exclusive Provider Organization
deductible
Referral
2. Is the provider who renders a service to a patient
(DME) Durable Medical Equipment
Treating or performing physician
IIHI
crossover claim
3. 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
Embezzlement
confidentiality
(ABN) Advance Beneficiary Notice
ordering physician
4. The period of time that payment for Medicare inpatient hospital benefits are available
premium
(DCI) Duplicate Coverage Inquiry
benefit period
Deductible
5. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
security officer
hmo
ee schedule
(UCR) Usual - Customary and Reasonable
6. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
ee schedule
pos
covered entity
Specialist
7. 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.
ee schedule
(DCI) Duplicate Coverage Inquiry
Notice of Privacy Practices
Consent form
8. 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
Claim
open panel HMO
Confidential communication
medical foundation
9. Unauthorized release of information
consulting physician
breach of confidential communication
Beneficiary
Specialist
10. Integrating benefits payable under more than one health insurance.
referral
econdary Payer
Coordinated Coverage
Treating or performing physician
11. 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
Medigap Insurance
Open Enrollment
e-health information management
econdary Payer
12. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(DOS) Date of Service
complience plan
electronic media
Beneficiary
13. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Allowed Expenses
attending physician
Experimental Procedures
14. 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
Pre-certification
breach of confidential communication
(TPA) Third Party Administrator
15. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
(PEC) Pre-existing condition
Experimental Procedures
Sub-acute Care
16. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
closed panel HMO
Protected health information
electronic media
(ERISA) Employee Retirement Income Security Act of 1974
17. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Protected health information
(TPA) Third Party Administrator
ids
nonprivileged information
18. 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
Coordinated Coverage
(AOB) Assignment of Benefits
AMA
19. 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
Experimental Procedures
(PCP) Primary Care Physician
epo
Beneficiary
20. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
privacy
ordering physician
Claim
HIPAA
21. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
complience plan
(UCR) Usual - Customary and Reasonable
(PEC) Pre-existing condition
business associate
22. 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
(ABN) Advance Beneficiary Notice
abuse
authorization form
23. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(TPA) Third Party Administrator
(ERISA) Employee Retirement Income Security Act of 1974
clearinghouse
Network
24. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
Resonable Charge
(PCP) Primary Care Physician
cash flow
25. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Covered Expenses
(DCI) Duplicate Coverage Inquiry
Individually identifiable health information
crossover claim
26. Standards of conduct generally accepted as a moral guide for behavior.
(PAC) Pre- Admission Certification
electronic media
Coordinated Coverage
ethics
27. 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
(COBRA)
(UR) Utilization review
epo
Treating or performing physician
28. 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
Privacy officer
hmo
prepaid plan
29. A monthly fee paid by the insured for specific medical insurance coverage
Covered Expenses
AMA
premium
Deductible
30. 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
cash flow
(COBRA)
Confidential communication
referral
31. Medical services provided on an outpatient basis
(UR) Utilization review
Amblatory Care
(COBRA)
(PPS) Hospital Impatient Prospective Payment System
32. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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33. 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
(AOB) Assignment of Benefits
Beneficiary
(POS) Point-of Service Plan
subscriber
34. 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.
clearinghouse
subscriber
business associate
health care provider
35. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PAC) Pre- Admission Certification
Preauthorization
transaction
Individually identifiable health information
36. 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
(EPO) Exclusive Provider Organization
pos
Consent form
consulting physician
37. A willful act by an employee of taking possession of an employer's money
(AOB) Assignment of Benefits
self-referral
Embezzlement
Privacy officer
38. Billing for services not performed
phantom billing
IIHI
Participating Provider
fraud
39. 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
business associate
Medigap Insurance
(POS) Point-of Service Plan
Network
40. 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
(TPA) Third Party Administrator
Experimental Procedures
open panel HMO
ids
41. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
econdary Payer
Privileged information
Network
pcp
42. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Embezzlement
complience
privacy
43. 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.
Individually identifiable health information
Protected health information
business associate
privacy
44. The amount of actual money available to the medical practice
authorization form
cash flow
(COBRA)
open panel HMO
45. 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
clearinghouse
Pre-existing Condition Exclusion
(APC) Ambulatory Patient Classifications
Network
46. 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
Consent form
Assignment & Authorization
(APC) Ambulatory Patient Classifications
Standard
47. What the insurance company will consider paying for as defined in the contract.
ee schedule
open panel HMO
(PAC) Pre- Admission Certification
Covered Expenses
48. A clinic that is owned by the HMO and the physicians are employees of the HMO
clearinghouse
closed panel HMO
subscriber
Notice of Privacy Practices
49. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Consent form
benefit period
(UR) Utilization review
Out of Network (OON)
50. A monthly fee paid by the insured for specific medical insurance coverage
premium
transaction
Protected health information
(COB) Coordination of Benefits