SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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 process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
etiquette
Amblatory Care
Deductible
complience
2. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(AOB) Assignment of Benefits
referral
pos
(UR) Utilization review
3. A clinic that is owned by the HMO and the physicians are employees of the HMO
subscriber
(DRG's)
closed panel HMO
prepaid plan
4. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Coordinated Coverage
Medigap Insurance
phantom billing
(OOPs) Out of Pocket Costs/Expenses
5. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
(DRG's)
Amblatory Care
(UR) Utilization review
6. 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
Supplementary Medical Insurance
Sub-acute Care
Security Rule
econdary Payer
7. Billing for services not performed
AMA
hmo
Specialist
phantom billing
8. 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
(ERISA) Employee Retirement Income Security Act of 1974
Consent form
AMA
Out of Network (OON)
9. 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
breach of confidential communication
(Non-par) Non-Participating Provider
authorization form
10. 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
Sub-acute Care
ee schedule
(AOB) Assignment of Benefits
11. 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)
Consent form
Pre-certification
Network
deductible
12. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Subscriber
Network
security officer
(AOB) Assignment of Benefits
13. A monthly fee paid by the insured for specific medical insurance coverage
premium
Sub-acute Care
fraud
Claim
14. Medicare's method of paying acute care hospitals for inpatient care
Network
complience plan
(PPS) Hospital Impatient Prospective Payment System
Pre-existing Condition Exclusion
15. 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
crossover claim
epo
Individually identifiable health information
econdary Payer
16. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Confidential communication
Deductible
econdary Payer
(TPA) Third Party Administrator
17. 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
Amblatory Care
epo
business associate
Referral
18. 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)
Confidential communication
Experimental Procedures
Pre-existing Condition Exclusion
19. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
ppo
etiquette
security officer
(TPA) Third Party Administrator
20. 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.
Allowed Expenses
econdary Payer
Network
health care provider
21. 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
Standard
phantom billing
Claim
22. Integrating benefits payable under more than one health insurance.
Privileged information
Treating or performing physician
Coordinated Coverage
phantom billing
23. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(ABN) Advance Beneficiary Notice
e-health information management
deductible
Resonable Charge
24. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Participating Provider
(TPA) Third Party Administrator
(Non-par) Non-Participating Provider
pcp
25. 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
Privileged information
Coordinated Coverage
Resonable Charge
nonprivileged information
26. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
security officer
pcp
transaction
27. The dates of healthcare services were provided to the beneficiary
Coordinated Coverage
etiquette
Assignment & Authorization
(DOS) Date of Service
28. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
(ABN) Advance Beneficiary Notice
cash flow
(Non-par) Non-Participating Provider
29. A review of the need for inpatient hospital care - completed before the actual admission
Preauthorization
Assignment & Authorization
(PAC) Pre- Admission Certification
(APC) Ambulatory Patient Classifications
30. 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
Experimental Procedures
consent
crossover claim
econdary Payer
31. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Open Enrollment
Privacy officer
Open Enrollment
claim
32. The condition of being secluded from the presence or view of others.
ethics
privacy
subscriber
closed panel HMO
33. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Security Rule
Maximum Out Of Pocket
transaction
nonprivileged information
34. Medical staff member who is legally responsible for the care and treatment given to a patient.
confidentiality
attending physician
Specialist
hmo
35. A privileged communication that may be disclosed only with the patient's permission.
Covered Expenses
Confidential communication
claim
breach of confidential communication
36. A provision that apples when a person is covered under more than one group medical program
(EPO) Exclusive Provider Organization
(COB) Coordination of Benefits
(UCR) Usual - Customary and Reasonable
health care provider
37. 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
business associate
authorization form
etiquette
e-health information management
38. Verbal or written agreement that gives approval to some action - situation - or statement.
pos
(COBRA)
(AOB) Assignment of Benefits
consent
39. 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
(TPA) Third Party Administrator
Subscriber
Supplementary Medical Insurance
Pre-certification
40. Health Information Portability and Accountability Act
HIPAA
self-referral
(ABN) Advance Beneficiary Notice
ppo
41. Billing for services not performed
Participating Provider
(COB) Coordination of Benefits
Allowed Expenses
phantom billing
42. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
epo
Referral
Network
HIPAA
43. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(EPO) Exclusive Provider Organization
econdary Payer
Beneficiary
preauthorization
44. Unauthorized release of information
(DRG's)
breach of confidential communication
e-health information management
referring physician
45. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
ppo
(APC) Ambulatory Patient Classifications
IIHI
46. 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.
Protected health information
Security Rule
Privacy officer
consent
47. 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
business associate
covered entity
ids
Maximum Out Of Pocket
48. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Claim
phantom billing
claim
ordering physician
49. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
consent
Embezzlement
Out of Network (OON)
Subscriber
50. 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
(ABN) Advance Beneficiary Notice
(PAC) Pre- Admission Certification
security officer
Experimental Procedures