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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. 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
pos
Security Rule
etiquette
Claim
2. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
Assignment & Authorization
Coordinated Coverage
etiquette
3. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
(APC) Ambulatory Patient Classifications
(POS) Point-of Service Plan
Treating or performing physician
Treating or performing physician
4. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Claim
Beneficiary
(EPO) Exclusive Provider Organization
(COBRA)
5. 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
authorization form
prepaid plan
nonprivileged information
6. 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
Covered Expenses
Pre-existing Condition Exclusion
7. 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
Security Rule
Medigap Insurance
ppo
Protected health information
8. American Medical Association
Deductible
AMA
crossover claim
Protected health information
9. 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
Network
(ERISA) Employee Retirement Income Security Act of 1974
medical foundation
Deductible
10. Unauthorized release of information
Open Enrollment
ee schedule
(UCR) Usual - Customary and Reasonable
breach of confidential communication
11. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
security officer
hmo
Deductible
(PPS) Hospital Impatient Prospective Payment System
12. 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.
AMA
Privacy officer
pcp
Privileged information
13. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Allowed Expenses
referral
abuse
Medigap Insurance
14. American Medical Association
Network
Claim
(DOS) Date of Service
AMA
15. 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
confidentiality
Deductible
(POS) Point-of Service Plan
Assignment & Authorization
16. 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
crossover claim
transaction
consent
17. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(POS) Point-of Service Plan
(OOPs) Out of Pocket Costs/Expenses
Sub-acute Care
Experimental Procedures
18. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
pcp
preauthorization
Notice of Privacy Practices
econdary Payer
19. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Amblatory Care
subscriber
Embezzlement
(UR) Utilization review
20. What the insurance company will consider paying for as defined in the contract.
Amblatory Care
Standard
Covered Expenses
Assignment & Authorization
21. 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
(PPS) Hospital Impatient Prospective Payment System
claim
confidentiality
covered entity
22. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
ee schedule
subscriber
complience
pos
23. 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)
(POS) Point-of Service Plan
closed panel HMO
ids
Consent form
24. 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
Open Enrollment
ethics
(PCP) Primary Care Physician
Consent form
25. A monthly fee paid by the insured for specific medical insurance coverage
(EPO) Exclusive Provider Organization
electronic media
transaction
premium
26. The transmission of information between two parties to carry out financial or administrative activities related to health care.
econdary Payer
(DOS) Date of Service
Pre-certification
transaction
27. Health Information Portability and Accountability Act
Preauthorization
IIHI
HIPAA
nonprivileged information
28. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(DRG's)
complience plan
Consent form
29. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
Amblatory Care
Participating Provider
confidentiality
30. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
fraud
breach of confidential communication
claim
31. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.
Referral
security officer
Security Rule
Referral
32. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(DOS) Date of Service
Medigap Insurance
Network
(PPS) Hospital Impatient Prospective Payment System
33. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
IIHI
breach of confidential communication
Preauthorization
34. 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
Pre-existing Condition Exclusion
subscriber
econdary Payer
breach of confidential communication
35. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
privacy
fraud
referral
fraud
36. 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
(ABN) Advance Beneficiary Notice
(PCP) Primary Care Physician
ids
HIPAA
37. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
breach of confidential communication
(EPO) Exclusive Provider Organization
ethics
38. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
IIHI
Medigap Insurance
Sub-acute Care
security officer
39. Someone who is eligible for or receiving benefits under an insurance policy or plan
privacy
Privacy officer
Beneficiary
phantom billing
40. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Embezzlement
HIPAA
Allowed Expenses
confidentiality
41. 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
Notice of Privacy Practices
(ABN) Advance Beneficiary Notice
authorization form
covered entity
42. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
(COB) Coordination of Benefits
pos
(PAC) Pre- Admission Certification
closed panel HMO
43. A willful act by an employee of taking possession of an employer's money
(AOB) Assignment of Benefits
e-health information management
Resonable Charge
Embezzlement
44. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(DME) Durable Medical Equipment
Resonable Charge
clearinghouse
self-referral
45. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Out of Network (OON)
Claim
Coordinated Coverage
disclosure
46. 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
(DCI) Duplicate Coverage Inquiry
Consent form
pos
Open Enrollment
47. 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
claim
nonprivileged information
Deductible
48. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(POS) Point-of Service Plan
Experimental Procedures
(PEC) Pre-existing condition
nonprivileged information
49. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
closed panel HMO
abuse
disclosure
Supplementary Medical Insurance
50. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
medical foundation
Privacy officer
(PEC) Pre-existing condition
Specialist
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