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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. Individually identifiable health information
Protected health information
(DOS) Date of Service
IIHI
Assignment & Authorization
2. An organization of provider sites with a contracted relationship that offer services
Assignment & Authorization
ids
Pre-existing Condition Exclusion
(DOS) Date of Service
3. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
subscriber
(POS) Point-of Service Plan
clearinghouse
Open Enrollment
4. Health Information Portability and Accountability Act
IIHI
Resonable Charge
consent
HIPAA
5. Health Information Portability and Accountability Act
benefit period
Allowed Expenses
HIPAA
Notice of Privacy Practices
6. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
ids
complience plan
Allowed Expenses
claim
7. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
premium
consulting physician
ethics
AMA
8. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Specialist
(DRG's)
e-health information management
disclosure
9. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
security officer
Network
medical foundation
(DCI) Duplicate Coverage Inquiry
10. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Privileged information
Resonable Charge
Network
11. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Individually identifiable health information
Beneficiary
abuse
Standard
12. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
pcp
ee schedule
pos
13. 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
business associate
Embezzlement
IIHI
Security Rule
14. The condition of being secluded from the presence or view of others.
Allowed Expenses
privacy
pos
preauthorization
15. 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
nonprivileged information
Claim
Assignment & Authorization
prepaid plan
16. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Assignment & Authorization
nonprivileged information
ordering physician
self-referral
17. 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
health care provider
Supplementary Medical Insurance
Sub-acute Care
privacy
18. 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
confidentiality
(Non-par) Non-Participating Provider
Consent form
consent
19. A list of the amount to be paid by an insurance company for each procedure service
abuse
self-referral
ee schedule
state preemption
20. 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.
Amblatory Care
clearinghouse
Privacy officer
covered entity
21. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
medical foundation
hmo
crossover claim
disclosure
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
Network
(APC) Ambulatory Patient Classifications
Participating Provider
phantom billing
23. A willful act by an employee of taking possession of an employer's money
Embezzlement
Notice of Privacy Practices
Maximum Out Of Pocket
Coordinated Coverage
24. Is a provider who sends the patients for testing or treatment
claim
referring physician
pos
Coordinated Coverage
25. 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
Supplementary Medical Insurance
Resonable Charge
health care provider
Network
26. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
e-health information management
epo
(OOPs) Out of Pocket Costs/Expenses
preauthorization
27. A structure for classifying outpatient services and procedures for purpose of payment
e-health information management
etiquette
security officer
(APC) Ambulatory Patient Classifications
28. 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
Security Rule
consulting physician
open panel HMO
nonprivileged information
29. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PPS) Hospital Impatient Prospective Payment System
complience
epo
(DME) Durable Medical Equipment
30. Standards of conduct generally accepted as a moral guide for behavior.
ethics
Specialist
Out of Network (OON)
Network
31. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Network
ordering physician
Individually identifiable health information
Assignment & Authorization
32. An intentional misrepresentation of the facts to deceive or mislead another.
premium
fraud
(Non-par) Non-Participating Provider
authorization form
33. A monthly fee paid by the insured for specific medical insurance coverage
premium
Supplementary Medical Insurance
(Non-par) Non-Participating Provider
Specialist
34. 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
(COBRA)
preauthorization
referring physician
Allowed Expenses
35. Billing for services not performed
Specialist
phantom billing
ordering physician
prepaid plan
36. 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
clearinghouse
Pre-existing Condition Exclusion
(POS) Point-of Service Plan
(PCP) Primary Care Physician
37. A review of the need for inpatient hospital care - completed before the actual admission
open panel HMO
Covered Expenses
(PAC) Pre- Admission Certification
preauthorization
38. Medical services provided on an outpatient basis
Amblatory Care
(POS) Point-of Service Plan
deductible
(DRG's)
39. Individually identifiable health information
clearinghouse
subscriber
(UR) Utilization review
IIHI
40. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
AMA
referral
(COBRA)
(COB) Coordination of Benefits
41. An organization of provider sites with a contracted relationship that offer services
Referral
health care provider
preauthorization
ids
42. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Standard
Sub-acute Care
(PEC) Pre-existing condition
Network
43. 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
(DME) Durable Medical Equipment
benefit period
Pre-existing Condition Exclusion
Resonable Charge
44. 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
Confidential communication
Embezzlement
(COB) Coordination of Benefits
45. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
Specialist
consulting physician
business associate
46. A structure for classifying outpatient services and procedures for purpose of payment
(POS) Point-of Service Plan
(APC) Ambulatory Patient Classifications
Confidential communication
confidentiality
47. 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
ids
Allowed Expenses
(DME) Durable Medical Equipment
authorization form
48. 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
ordering physician
Pre-existing Condition Exclusion
Privacy officer
Maximum Out Of Pocket
49. Is a provider who sends the patients for testing or treatment
business associate
referring physician
(EPO) Exclusive Provider Organization
(DCI) Duplicate Coverage Inquiry
50. 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.
(ERISA) Employee Retirement Income Security Act of 1974
(DOS) Date of Service
Notice of Privacy Practices
(TPA) Third Party Administrator