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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Study First
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. Customs - rules of conduct - courtesy - and manners of the medical profession
(PAC) Pre- Admission Certification
pcp
etiquette
(AOB) Assignment of Benefits
2. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Open Enrollment
Claim
disclosure
Resonable Charge
3. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
Notice of Privacy Practices
(DRG's)
(Non-par) Non-Participating Provider
4. A provision that apples when a person is covered under more than one group medical program
Supplementary Medical Insurance
benefit period
(COB) Coordination of Benefits
Network
5. A clinic that is owned by the HMO and the physicians are employees of the HMO
claim
closed panel HMO
security officer
Medigap Insurance
6. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
covered entity
(AOB) Assignment of Benefits
Assignment & Authorization
(Non-par) Non-Participating Provider
7. Standards of conduct generally accepted as a moral guide for behavior.
(PCN) Primary Care Network
Individually identifiable health information
Maximum Out Of Pocket
ethics
8. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
transaction
(PEC) Pre-existing condition
ordering physician
breach of confidential communication
9. An organization of provider sites with a contracted relationship that offer services
Referral
Coordinated Coverage
ids
Experimental Procedures
10. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
(APC) Ambulatory Patient Classifications
Specialist
benefit period
11. 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
Beneficiary
pcp
ppo
claim
12. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
(UR) Utilization review
cash flow
(PCN) Primary Care Network
13. A structure for classifying outpatient services and procedures for purpose of payment
Participating Provider
(UCR) Usual - Customary and Reasonable
Claim
(APC) Ambulatory Patient Classifications
14. A patient claim is eligible for medicare and medicaid
etiquette
crossover claim
medical foundation
ids
15. The period of time that payment for Medicare inpatient hospital benefits are available
(COBRA)
benefit period
hmo
Privileged information
16. 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
Privacy officer
HIPAA
Open Enrollment
17. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Sub-acute Care
electronic media
privacy
18. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
subscriber
Experimental Procedures
(DRG's)
19. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Medigap Insurance
abuse
hmo
Individually identifiable health information
20. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
electronic media
premium
complience plan
(OOPs) Out of Pocket Costs/Expenses
21. Medicare's method of paying acute care hospitals for inpatient care
Treating or performing physician
ordering physician
(PPS) Hospital Impatient Prospective Payment System
referring physician
22. 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
Claim
econdary Payer
Subscriber
fraud
23. The transmission of information between two parties to carry out financial or administrative activities related to health care.
IIHI
transaction
(COB) Coordination of Benefits
(APC) Ambulatory Patient Classifications
24. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
ids
Resonable Charge
referring physician
cash flow
25. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Notice of Privacy Practices
pos
consulting physician
26. A willful act by an employee of taking possession of an employer's money
complience plan
Resonable Charge
medical foundation
Embezzlement
27. 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.
open panel HMO
medical foundation
Sub-acute Care
Notice of Privacy Practices
28. The amount of actual money available to the medical practice
(PCN) Primary Care Network
(POS) Point-of Service Plan
cash flow
(COB) Coordination of Benefits
29. 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
(DCI) Duplicate Coverage Inquiry
Assignment & Authorization
AMA
(APC) Ambulatory Patient Classifications
30. 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
security officer
Assignment & Authorization
pcp
Experimental Procedures
31. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
fraud
(PCP) Primary Care Physician
Covered Expenses
Claim
32. 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
complience plan
(PCP) Primary Care Physician
(PCN) Primary Care Network
(Non-par) Non-Participating Provider
33. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.
ordering physician
complience
AMA
security officer
34. 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
Pre-certification
(COBRA)
HIPAA
35. Medical services provided on an outpatient basis
Allowed Expenses
Amblatory Care
breach of confidential communication
(TPA) Third Party Administrator
36. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
nonprivileged information
Security Rule
Deductible
Preauthorization
37. 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
Pre-certification
Subscriber
(ABN) Advance Beneficiary Notice
38. A monthly fee paid by the insured for specific medical insurance coverage
premium
Privileged information
Specialist
Participating Provider
39. Is the provider who renders a service to a patient
medical foundation
(TPA) Third Party Administrator
(APC) Ambulatory Patient Classifications
Treating or performing physician
40. 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
(TPA) Third Party Administrator
(COBRA)
(POS) Point-of Service Plan
Pre-existing Condition Exclusion
41. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
42. 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)
Subscriber
(DRG's)
premium
43. Is a provider who sends the patients for testing or treatment
pcp
(DME) Durable Medical Equipment
referring physician
(ERISA) Employee Retirement Income Security Act of 1974
44. 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
Experimental Procedures
Beneficiary
pos
Allowed Expenses
45. 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
Privacy officer
complience plan
(Non-par) Non-Participating Provider
46. 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
etiquette
ordering physician
Consent form
47. 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
IIHI
Treating or performing physician
Maximum Out Of Pocket
Pre-existing Condition Exclusion
48. 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
self-referral
(TPA) Third Party Administrator
ppo
Referral
49. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Subscriber
Treating or performing physician
Network
disclosure
50. 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
Medigap Insurance
(PCN) Primary Care Network
(PCP) Primary Care Physician
transaction