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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 clinic that is owned by the HMO and the physicians are employees of the HMO
Network
closed panel HMO
benefit period
Individually identifiable health information
2. 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.
(COBRA)
Protected health information
crossover claim
Claim
3. 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
Notice of Privacy Practices
Security Rule
(OOPs) Out of Pocket Costs/Expenses
(EPO) Exclusive Provider Organization
4. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
confidentiality
Resonable Charge
Treating or performing physician
Individually identifiable health information
5. 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
(OOPs) Out of Pocket Costs/Expenses
(PCN) Primary Care Network
Out of Network (OON)
nonprivileged information
6. Billing for services not performed
(ABN) Advance Beneficiary Notice
complience plan
electronic media
phantom billing
7. A clinic that is owned by the HMO and the physicians are employees of the HMO
ethics
open panel HMO
closed panel HMO
complience plan
8. Is the provider who renders a service to a patient
pos
authorization form
Treating or performing physician
(PPS) Hospital Impatient Prospective Payment System
9. A structure for classifying outpatient services and procedures for purpose of payment
pcp
(APC) Ambulatory Patient Classifications
Security Rule
(TPA) Third Party Administrator
10. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
state preemption
(EPO) Exclusive Provider Organization
clearinghouse
complience
11. 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
Preauthorization
Deductible
(UR) Utilization review
HIPAA
12. 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
Out of Network (OON)
Experimental Procedures
benefit period
Open Enrollment
13. 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
Supplementary Medical Insurance
(EPO) Exclusive Provider Organization
Privacy officer
Preauthorization
14. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
phantom billing
(ERISA) Employee Retirement Income Security Act of 1974
breach of confidential communication
pcp
15. 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
ids
(PCP) Primary Care Physician
pos
(DOS) Date of Service
16. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
subscriber
health care provider
disclosure
Specialist
17. 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.
ee schedule
state preemption
benefit period
Experimental Procedures
18. Health Information Portability and Accountability Act
HIPAA
premium
(DOS) Date of Service
Assignment & Authorization
19. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
HIPAA
e-health information management
security officer
abuse
20. 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
Amblatory Care
etiquette
fraud
21. 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
business associate
(COB) Coordination of Benefits
(PPS) Hospital Impatient Prospective Payment System
22. 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
Amblatory Care
Specialist
covered entity
(EPO) Exclusive Provider Organization
23. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
econdary Payer
(OOPs) Out of Pocket Costs/Expenses
ordering physician
fraud
24. Is a provider who sends the patients for testing or treatment
claim
prepaid plan
referring physician
self-referral
25. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Sub-acute Care
Pre-existing Condition Exclusion
Resonable Charge
abuse
26. A structure for classifying outpatient services and procedures for purpose of payment
electronic media
Allowed Expenses
health care provider
(APC) Ambulatory Patient Classifications
27. 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
crossover claim
(COBRA)
Embezzlement
electronic media
28. 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
(ERISA) Employee Retirement Income Security Act of 1974
epo
(DME) Durable Medical Equipment
complience plan
29. 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
business associate
(DCI) Duplicate Coverage Inquiry
(TPA) Third Party Administrator
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
Notice of Privacy Practices
Assignment & Authorization
Deductible
consulting physician
31. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
electronic media
Network
(COB) Coordination of Benefits
Notice of Privacy Practices
32. A patient claim is eligible for medicare and medicaid
crossover claim
(APC) Ambulatory Patient Classifications
security officer
(PPS) Hospital Impatient Prospective Payment System
33. Someone who is eligible for or receiving benefits under an insurance policy or plan
(PCP) Primary Care Physician
deductible
(EPO) Exclusive Provider Organization
Beneficiary
34. 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
(PCN) Primary Care Network
HIPAA
ordering physician
medical foundation
35. The period of time that payment for Medicare inpatient hospital benefits are available
Confidential communication
pcp
benefit period
(DME) Durable Medical Equipment
36. A list of the amount to be paid by an insurance company for each procedure service
transaction
ee schedule
premium
(TPA) Third Party Administrator
37. 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
business associate
Network
abuse
38. 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
health care provider
econdary Payer
(AOB) Assignment of Benefits
epo
39. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
security officer
Preauthorization
crossover claim
40. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Resonable Charge
abuse
Pre-certification
Sub-acute Care
41. 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)
Subscriber
Claim
Individually identifiable health information
Consent form
42. 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.
(PCP) Primary Care Physician
state preemption
benefit period
Notice of Privacy Practices
43. 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
benefit period
(TPA) Third Party Administrator
(ERISA) Employee Retirement Income Security Act of 1974
(APC) Ambulatory Patient Classifications
44. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
(DOS) Date of Service
ethics
(APC) Ambulatory Patient Classifications
45. A provision that apples when a person is covered under more than one group medical program
Allowed Expenses
(COB) Coordination of Benefits
Protected health information
HIPAA
46. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Subscriber
(PPS) Hospital Impatient Prospective Payment System
Referral
47. 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
disclosure
Specialist
epo
self-referral
48. Individually identifiable health information
IIHI
(Non-par) Non-Participating Provider
ordering physician
confidentiality
49. American Medical Association
AMA
crossover claim
IIHI
Subscriber
50. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
clearinghouse
Pre-certification
Sub-acute Care
pos