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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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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. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
fraud
subscriber
closed panel HMO
cash flow
2. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
referring physician
Claim
Privacy officer
3. 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
attending physician
Resonable Charge
business associate
Maximum Out Of Pocket
4. Medical services provided on an outpatient basis
(DRG's)
consent
Amblatory Care
abuse
5. A rule - condition - or requirement
Standard
(APC) Ambulatory Patient Classifications
etiquette
covered entity
6. 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.
Treating or performing physician
disclosure
Notice of Privacy Practices
premium
7. The dates of healthcare services were provided to the beneficiary
Pre-existing Condition Exclusion
(DOS) Date of Service
(DRG's)
Pre-certification
8. Billing for services not performed
phantom billing
consent
Beneficiary
security officer
9. A privileged communication that may be disclosed only with the patient's permission.
ppo
pos
Confidential communication
(UCR) Usual - Customary and Reasonable
10. The condition of being secluded from the presence or view of others.
(PCP) Primary Care Physician
HIPAA
privacy
(EPO) Exclusive Provider Organization
11. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(PEC) Pre-existing condition
preauthorization
(UR) Utilization review
(COB) Coordination of Benefits
12. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(COBRA)
Allowed Expenses
referring physician
referral
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
Preauthorization
Experimental Procedures
ids
complience
14. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(PPS) Hospital Impatient Prospective Payment System
Sub-acute Care
(OOPs) Out of Pocket Costs/Expenses
15. Customs - rules of conduct - courtesy - and manners of the medical profession
Covered Expenses
etiquette
phantom billing
prepaid plan
16. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
premium
(POS) Point-of Service Plan
confidentiality
closed panel HMO
17. A nonprofit integrated delivery system
authorization form
medical foundation
claim
ee schedule
18. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Embezzlement
(UR) Utilization review
Subscriber
disclosure
19. The period of time that payment for Medicare inpatient hospital benefits are available
electronic media
benefit period
Experimental Procedures
etiquette
20. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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21. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
covered entity
(PPS) Hospital Impatient Prospective Payment System
Standard
22. 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
Deductible
benefit period
IIHI
Participating Provider
23. The maximum amount a plan pays for a covered service
HIPAA
benefit period
Allowed Expenses
ordering physician
24. 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.
subscriber
Protected health information
state preemption
Confidential communication
25. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
IIHI
Maximum Out Of Pocket
Privacy officer
(COB) Coordination of Benefits
26. Someone who is eligible for or receiving benefits under an insurance policy or plan
covered entity
ids
Beneficiary
consent
27. Individually identifiable health information
IIHI
Confidential communication
(POS) Point-of Service Plan
ee schedule
28. Approval or consent by a primary physician for patient referral to ancillary services and specialists
health care provider
Referral
Allowed Expenses
state preemption
29. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
(PCP) Primary Care Physician
ordering physician
hmo
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
(UCR) Usual - Customary and Reasonable
referral
(COBRA)
ethics
31. The dates of healthcare services were provided to the beneficiary
complience plan
Open Enrollment
(DOS) Date of Service
econdary Payer
32. Medical services provided on an outpatient basis
(APC) Ambulatory Patient Classifications
(AOB) Assignment of Benefits
(DCI) Duplicate Coverage Inquiry
Amblatory Care
33. 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
Privacy officer
transaction
open panel HMO
34. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
consulting physician
(ABN) Advance Beneficiary Notice
referral
(EPO) Exclusive Provider Organization
35. Integrating benefits payable under more than one health insurance.
(OOPs) Out of Pocket Costs/Expenses
HIPAA
preauthorization
Coordinated Coverage
36. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Standard
benefit period
benefit period
37. 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
pcp
(EPO) Exclusive Provider Organization
Maximum Out Of Pocket
pos
38. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Subscriber
(PEC) Pre-existing condition
(PPS) Hospital Impatient Prospective Payment System
abuse
39. 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
Sub-acute Care
econdary Payer
self-referral
consulting physician
40. The maximum amount a plan pays for a covered service
Claim
(Non-par) Non-Participating Provider
Subscriber
Allowed Expenses
41. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Maximum Out Of Pocket
consulting physician
open panel HMO
42. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
(UR) Utilization review
Privacy officer
nonprivileged information
complience
43. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
authorization form
(UCR) Usual - Customary and Reasonable
Resonable Charge
abuse
44. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Out of Network (OON)
Coordinated Coverage
e-health information management
prepaid plan
45. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Allowed Expenses
Individually identifiable health information
crossover claim
46. 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
Supplementary Medical Insurance
authorization form
Sub-acute Care
Network
47. 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
complience
HIPAA
nonprivileged information
econdary Payer
48. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Embezzlement
Privacy officer
Beneficiary
(UCR) Usual - Customary and Reasonable
49. 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
deductible
Standard
Pre-existing Condition Exclusion
(UR) Utilization review
50. 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
authorization form
(UCR) Usual - Customary and Reasonable
Supplementary Medical Insurance
AMA