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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.
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 provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Individually identifiable health information
consulting physician
authorization form
(DOS) Date of Service
2. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Subscriber
ordering physician
ee schedule
referral
3. 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
clearinghouse
consulting physician
(AOB) Assignment of Benefits
prepaid plan
4. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Experimental Procedures
electronic media
authorization form
5. 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.
Privacy officer
(POS) Point-of Service Plan
Assignment & Authorization
Amblatory Care
6. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Specialist
consent
Subscriber
7. Billing for services not performed
confidentiality
phantom billing
Protected health information
(DCI) Duplicate Coverage Inquiry
8. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
clearinghouse
phantom billing
electronic media
security officer
9. The period of time that payment for Medicare inpatient hospital benefits are available
Open Enrollment
benefit period
Specialist
Out of Network (OON)
10. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Participating Provider
covered entity
disclosure
complience plan
11. 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
Beneficiary
Maximum Out Of Pocket
claim
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
(ABN) Advance Beneficiary Notice
nonprivileged information
HIPAA
attending physician
13. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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14. 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
closed panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
crossover claim
nonprivileged information
15. Medical services provided on an outpatient basis
(APC) Ambulatory Patient Classifications
Amblatory Care
privacy
benefit period
16. Is a provider who sends the patients for testing or treatment
Security Rule
referring physician
Maximum Out Of Pocket
Subscriber
17. 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
confidentiality
(PEC) Pre-existing condition
Medigap Insurance
(PCP) Primary Care Physician
18. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
e-health information management
Assignment & Authorization
Open Enrollment
(DME) Durable Medical Equipment
19. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
referring physician
ordering physician
authorization form
e-health information management
20. A willful act by an employee of taking possession of an employer's money
open panel HMO
privacy
Embezzlement
open panel HMO
21. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
econdary Payer
clearinghouse
(DME) Durable Medical Equipment
open panel HMO
22. A list of the amount to be paid by an insurance company for each procedure service
closed panel HMO
Subscriber
ee schedule
(APC) Ambulatory Patient Classifications
23. A patient claim is eligible for medicare and medicaid
crossover claim
ppo
clearinghouse
authorization form
24. A clinic that is owned by the HMO and the physicians are employees of the HMO
Subscriber
closed panel HMO
Claim
Claim
25. The dates of healthcare services were provided to the beneficiary
(Non-par) Non-Participating Provider
IIHI
ordering physician
(DOS) Date of Service
26. Unauthorized release of information
(POS) Point-of Service Plan
(UR) Utilization review
Confidential communication
breach of confidential communication
27. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
ppo
complience
preauthorization
28. 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.
(APC) Ambulatory Patient Classifications
(ERISA) Employee Retirement Income Security Act of 1974
Notice of Privacy Practices
hmo
29. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
self-referral
(EPO) Exclusive Provider Organization
nonprivileged information
30. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PCN) Primary Care Network
complience
Medigap Insurance
(DRG's)
31. A rule - condition - or requirement
self-referral
consent
Amblatory Care
Standard
32. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Claim
ordering physician
self-referral
confidentiality
33. 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
abuse
Assignment & Authorization
Preauthorization
e-health information management
34. Medical services provided on an outpatient basis
Pre-certification
Amblatory Care
Coordinated Coverage
Consent form
35. 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.
Participating Provider
(PPS) Hospital Impatient Prospective Payment System
breach of confidential communication
Privacy officer
36. 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
business associate
Medigap Insurance
(Non-par) Non-Participating Provider
phantom billing
37. Health Information Portability and Accountability Act
Subscriber
Supplementary Medical Insurance
IIHI
HIPAA
38. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
deductible
Out of Network (OON)
preauthorization
Pre-certification
39. 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
phantom billing
premium
40. Customs - rules of conduct - courtesy - and manners of the medical profession
security officer
Sub-acute Care
Consent form
etiquette
41. 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
Preauthorization
Protected health information
(DME) Durable Medical Equipment
42. 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
(DOS) Date of Service
clearinghouse
(DCI) Duplicate Coverage Inquiry
43. The dates of healthcare services were provided to the beneficiary
Security Rule
(DOS) Date of Service
premium
crossover claim
44. 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
(EPO) Exclusive Provider Organization
Assignment & Authorization
fraud
Resonable Charge
45. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Deductible
Security Rule
Allowed Expenses
46. Medicare's method of paying acute care hospitals for inpatient care
epo
(PPS) Hospital Impatient Prospective Payment System
Preauthorization
claim
47. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
consulting physician
transaction
Individually identifiable health information
business associate
48. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
econdary Payer
attending physician
Network
Privacy officer
49. 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
medical foundation
Supplementary Medical Insurance
Sub-acute Care
(COB) Coordination of Benefits
50. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(APC) Ambulatory Patient Classifications
Claim
Confidential communication
ordering physician