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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 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
Network
clearinghouse
(PCN) Primary Care Network
closed panel HMO
2. 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.
Notice of Privacy Practices
Open Enrollment
Deductible
benefit period
3. A monthly fee paid by the insured for specific medical insurance coverage
premium
(OOPs) Out of Pocket Costs/Expenses
crossover claim
breach of confidential communication
4. A review of the need for inpatient hospital care - completed before the actual admission
Confidential communication
medical foundation
ethics
(PAC) Pre- Admission Certification
5. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
nonprivileged information
closed panel HMO
(TPA) Third Party Administrator
Subscriber
6. American Medical Association
disclosure
(PCN) Primary Care Network
referral
AMA
7. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
epo
Embezzlement
(PCN) Primary Care Network
8. A structure for classifying outpatient services and procedures for purpose of payment
(DOS) Date of Service
subscriber
self-referral
(APC) Ambulatory Patient Classifications
9. Approval or consent by a primary physician for patient referral to ancillary services and specialists
AMA
Referral
self-referral
complience plan
10. Is the provider who renders a service to a patient
Out of Network (OON)
(DCI) Duplicate Coverage Inquiry
Experimental Procedures
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
transaction
security officer
econdary Payer
Referral
12. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(DME) Durable Medical Equipment
Protected health information
ethics
(UCR) Usual - Customary and Reasonable
13. 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
epo
(AOB) Assignment of Benefits
Supplementary Medical Insurance
etiquette
14. A patient claim is eligible for medicare and medicaid
(ABN) Advance Beneficiary Notice
crossover claim
confidentiality
(COBRA)
15. 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.
breach of confidential communication
medical foundation
electronic media
Notice of Privacy Practices
16. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
pcp
Supplementary Medical Insurance
referral
(APC) Ambulatory Patient Classifications
17. 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
(COB) Coordination of Benefits
consent
Participating Provider
Confidential communication
18. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(POS) Point-of Service Plan
(EPO) Exclusive Provider Organization
econdary Payer
etiquette
19. Is the provider who renders a service to a patient
Treating or performing physician
Preauthorization
Coordinated Coverage
privacy
20. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
phantom billing
consent
Allowed Expenses
Claim
21. A nonprofit integrated delivery system
referring physician
medical foundation
Referral
Open Enrollment
22. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
health care provider
(ABN) Advance Beneficiary Notice
e-health information management
(TPA) Third Party Administrator
23. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Allowed Expenses
econdary Payer
ordering physician
ids
24. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(UCR) Usual - Customary and Reasonable
Subscriber
(COB) Coordination of Benefits
(PEC) Pre-existing condition
25. 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
business associate
Allowed Expenses
Preauthorization
(PCP) Primary Care Physician
26. 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
(UCR) Usual - Customary and Reasonable
(AOB) Assignment of Benefits
Supplementary Medical Insurance
Amblatory Care
27. 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
open panel HMO
epo
nonprivileged information
fraud
28. The transmission of information between two parties to carry out financial or administrative activities related to health care.
premium
transaction
(POS) Point-of Service Plan
Privacy officer
29. 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
Pre-certification
(COB) Coordination of Benefits
ethics
30. The period of time that payment for Medicare inpatient hospital benefits are available
(EPO) Exclusive Provider Organization
(PPS) Hospital Impatient Prospective Payment System
benefit period
Medigap Insurance
31. 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.
pos
Protected health information
disclosure
hmo
32. Medicare's method of paying acute care hospitals for inpatient care
Experimental Procedures
(OOPs) Out of Pocket Costs/Expenses
(PPS) Hospital Impatient Prospective Payment System
clearinghouse
33. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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34. 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.
Supplementary Medical Insurance
claim
health care provider
Supplementary Medical Insurance
35. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
ee schedule
Privileged information
state preemption
36. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
complience plan
prepaid plan
epo
37. 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
(UR) Utilization review
(PCN) Primary Care Network
(COBRA)
ppo
38. 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
(POS) Point-of Service Plan
ethics
Supplementary Medical Insurance
(COBRA)
39. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Out of Network (OON)
hmo
medical foundation
Subscriber
40. 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
HIPAA
(PCP) Primary Care Physician
Individually identifiable health information
(Non-par) Non-Participating Provider
41. 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
(TPA) Third Party Administrator
(AOB) Assignment of Benefits
Privacy officer
AMA
42. A nonprofit integrated delivery system
medical foundation
Supplementary Medical Insurance
fraud
Experimental Procedures
43. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Consent form
etiquette
(EPO) Exclusive Provider Organization
hmo
44. 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
(PCP) Primary Care Physician
Security Rule
(Non-par) Non-Participating Provider
45. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou
AMA
Subscriber
Consent form
Sub-acute Care
46. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
health care provider
(PAC) Pre- Admission Certification
(ABN) Advance Beneficiary Notice
47. 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
(PCP) Primary Care Physician
(Non-par) Non-Participating Provider
clearinghouse
closed panel HMO
48. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Experimental Procedures
ordering physician
etiquette
Network
49. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
self-referral
Pre-existing Condition Exclusion
claim
abuse
50. 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
crossover claim
phantom billing
medical foundation
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