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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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.
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 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
covered entity
Network
Allowed Expenses
2. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Sub-acute Care
(UCR) Usual - Customary and Reasonable
phantom billing
etiquette
3. 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
Referral
(UR) Utilization review
Sub-acute Care
authorization form
4. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(ABN) Advance Beneficiary Notice
Experimental Procedures
disclosure
pcp
5. 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
Resonable Charge
(DCI) Duplicate Coverage Inquiry
Preauthorization
Out of Network (OON)
6. 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
pcp
(DME) Durable Medical Equipment
medical foundation
Pre-existing Condition Exclusion
7. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
(UCR) Usual - Customary and Reasonable
ids
Beneficiary
8. A monthly fee paid by the insured for specific medical insurance coverage
Privacy officer
Security Rule
premium
Specialist
9. Individually identifiable health information
Pre-certification
IIHI
state preemption
Specialist
10. 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
covered entity
Out of Network (OON)
etiquette
(Non-par) Non-Participating Provider
11. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
pos
Amblatory Care
Embezzlement
Subscriber
12. Individually identifiable health information
IIHI
complience
claim
(COBRA)
13. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.
business associate
covered entity
(POS) Point-of Service Plan
ppo
14. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
(APC) Ambulatory Patient Classifications
fraud
(APC) Ambulatory Patient Classifications
15. 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.
pos
Privacy officer
ppo
abuse
16. A list of the amount to be paid by an insurance company for each procedure service
Covered Expenses
transaction
Embezzlement
ee schedule
17. A rule - condition - or requirement
IIHI
Standard
Resonable Charge
benefit period
18. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Deductible
hmo
Consent form
(UCR) Usual - Customary and Reasonable
19. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
Privacy officer
prepaid plan
Privileged information
20. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Claim
Sub-acute Care
state preemption
21. 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)
authorization form
Consent form
prepaid plan
Participating Provider
22. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
transaction
electronic media
Maximum Out Of Pocket
attending physician
23. The amount of actual money available to the medical practice
Specialist
pos
cash flow
Network
24. A nonprofit integrated delivery system
covered entity
deductible
medical foundation
closed panel HMO
25. Is the provider who renders a service to a patient
(TPA) Third Party Administrator
(PPS) Hospital Impatient Prospective Payment System
Treating or performing physician
Referral
26. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(UCR) Usual - Customary and Reasonable
consulting physician
state preemption
Medigap Insurance
27. An organization of provider sites with a contracted relationship that offer services
health care provider
Claim
(UR) Utilization review
ids
28. 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
ordering physician
(DME) Durable Medical Equipment
Participating Provider
closed panel HMO
29. Someone who is eligible for or receiving benefits under an insurance policy or plan
complience
Beneficiary
Pre-certification
prepaid plan
30. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(ABN) Advance Beneficiary Notice
Covered Expenses
econdary Payer
claim
31. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
Referral
(DCI) Duplicate Coverage Inquiry
state preemption
32. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
Medigap Insurance
fraud
ppo
Protected health information
33. 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
Security Rule
(ABN) Advance Beneficiary Notice
abuse
health care provider
34. 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
pcp
(AOB) Assignment of Benefits
AMA
Privacy officer
35. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
confidentiality
econdary Payer
phantom billing
36. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Pre-certification
health care provider
referring physician
hmo
37. Unauthorized release of information
Treating or performing physician
breach of confidential communication
(OOPs) Out of Pocket Costs/Expenses
cash flow
38. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Privacy officer
confidentiality
referring physician
complience
39. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Resonable Charge
Participating Provider
(PEC) Pre-existing condition
(AOB) Assignment of Benefits
40. Billing for services not performed
business associate
(PPS) Hospital Impatient Prospective Payment System
phantom billing
Deductible
41. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Deductible
(ERISA) Employee Retirement Income Security Act of 1974
(TPA) Third Party Administrator
phantom billing
42. Integrating benefits payable under more than one health insurance.
ee schedule
IIHI
Coordinated Coverage
hmo
43. 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
Privileged information
(DCI) Duplicate Coverage Inquiry
(Non-par) Non-Participating Provider
(DRG's)
44. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
breach of confidential communication
ee schedule
(TPA) Third Party Administrator
45. 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
complience
(Non-par) Non-Participating Provider
clearinghouse
Maximum Out Of Pocket
46. 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
econdary Payer
(COBRA)
referral
ethics
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.
Supplementary Medical Insurance
abuse
Individually identifiable health information
(Non-par) Non-Participating Provider
48. The period of time that payment for Medicare inpatient hospital benefits are available
claim
Referral
Embezzlement
benefit period
49. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
(APC) Ambulatory Patient Classifications
Beneficiary
ee schedule
50. American Medical Association
Preauthorization
AMA
(ERISA) Employee Retirement Income Security Act of 1974
Subscriber