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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 practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated
Out of Network (OON)
Pre-existing Condition Exclusion
Allowed Expenses
Experimental Procedures
2. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
(UR) Utilization review
business associate
abuse
3. 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.
disclosure
health care provider
Out of Network (OON)
clearinghouse
4. 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
Claim
hmo
(AOB) Assignment of Benefits
Security Rule
5. 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
abuse
prepaid plan
authorization form
6. 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
Embezzlement
Notice of Privacy Practices
fraud
Experimental Procedures
7. 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.
premium
Privileged information
(PCN) Primary Care Network
preauthorization
8. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(DRG's)
(EPO) Exclusive Provider Organization
(PPS) Hospital Impatient Prospective Payment System
open panel HMO
9. 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
Specialist
Network
authorization form
referral
10. 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
(COBRA)
(DRG's)
(TPA) Third Party Administrator
Preauthorization
11. 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
(PPS) Hospital Impatient Prospective Payment System
authorization form
(UCR) Usual - Customary and Reasonable
disclosure
12. 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
(PEC) Pre-existing condition
Beneficiary
Specialist
(ABN) Advance Beneficiary Notice
13. A list of the amount to be paid by an insurance company for each procedure service
(COB) Coordination of Benefits
Claim
subscriber
ee schedule
14. 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.
Medigap Insurance
(DOS) Date of Service
Pre-existing Condition Exclusion
business associate
15. 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
Participating Provider
(DOS) Date of Service
Claim
(AOB) Assignment of Benefits
16. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(EPO) Exclusive Provider Organization
Preauthorization
(PEC) Pre-existing condition
transaction
17. Integrating benefits payable under more than one health insurance.
Treating or performing physician
Coordinated Coverage
state preemption
abuse
18. 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.
(DRG's)
phantom billing
Notice of Privacy Practices
(PAC) Pre- Admission Certification
19. Verbal or written agreement that gives approval to some action - situation - or statement.
fraud
consent
Referral
Sub-acute Care
20. 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
(OOPs) Out of Pocket Costs/Expenses
confidentiality
(Non-par) Non-Participating Provider
Pre-existing Condition Exclusion
21. 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
Embezzlement
health care provider
(DOS) Date of Service
22. 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
HIPAA
crossover claim
(PCP) Primary Care Physician
benefit period
23. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Participating Provider
complience
claim
referring physician
24. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Amblatory Care
complience plan
phantom billing
ethics
25. 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
claim
Supplementary Medical Insurance
Privacy officer
(DME) Durable Medical Equipment
26. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
complience
medical foundation
ordering physician
Preauthorization
27. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
preauthorization
(PCN) Primary Care Network
Embezzlement
28. Medical staff member who is legally responsible for the care and treatment given to a patient.
Sub-acute Care
attending physician
hmo
benefit period
29. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
(APC) Ambulatory Patient Classifications
cash flow
Embezzlement
30. 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
electronic media
etiquette
(PCN) Primary Care Network
Amblatory Care
31. A willful act by an employee of taking possession of an employer's money
privacy
authorization form
Embezzlement
Pre-existing Condition Exclusion
32. 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
Amblatory Care
ee schedule
Claim
nonprivileged information
33. 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
(COBRA)
open panel HMO
benefit period
crossover claim
34. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
Open Enrollment
ordering physician
Maximum Out Of Pocket
35. Customs - rules of conduct - courtesy - and manners of the medical profession
Supplementary Medical Insurance
complience
complience
etiquette
36. 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
prepaid plan
Medigap Insurance
deductible
nonprivileged information
37. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Referral
(COBRA)
preauthorization
38. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
complience plan
abuse
subscriber
etiquette
39. Medical services provided on an outpatient basis
Embezzlement
Maximum Out Of Pocket
Amblatory Care
(DOS) Date of Service
40. An intentional misrepresentation of the facts to deceive or mislead another.
e-health information management
fraud
econdary Payer
(EPO) Exclusive Provider Organization
41. 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
nonprivileged information
Coordinated Coverage
Experimental Procedures
Network
42. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
abuse
Supplementary Medical Insurance
pcp
ppo
43. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Supplementary Medical Insurance
AMA
(UCR) Usual - Customary and Reasonable
ordering physician
44. 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
electronic media
Beneficiary
Referral
45. 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
fraud
HIPAA
epo
pos
46. Individually identifiable health information
Consent form
Treating or performing physician
Medigap Insurance
IIHI
47. Approval or consent by a primary physician for patient referral to ancillary services and specialists
prepaid plan
Coordinated Coverage
Protected health information
Referral
48. 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
Assignment & Authorization
open panel HMO
complience plan
(ERISA) Employee Retirement Income Security Act of 1974
49. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
epo
(OOPs) Out of Pocket Costs/Expenses
Preauthorization
(DOS) Date of Service
50. The amount of actual money available to the medical practice
Supplementary Medical Insurance
ordering physician
privacy
cash flow