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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. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
authorization form
attending physician
Protected health information
(AOB) Assignment of Benefits
2. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
health care provider
Confidential communication
(UR) Utilization review
Experimental Procedures
3. Standards of conduct generally accepted as a moral guide for behavior.
(COB) Coordination of Benefits
transaction
Sub-acute Care
ethics
4. Customs - rules of conduct - courtesy - and manners of the medical profession
clearinghouse
Notice of Privacy Practices
Participating Provider
etiquette
5. An intentional misrepresentation of the facts to deceive or mislead another.
Network
fraud
Standard
complience plan
6. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
privacy
state preemption
hmo
pos
7. A nonprofit integrated delivery system
Treating or performing physician
cash flow
Notice of Privacy Practices
medical foundation
8. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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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
(PEC) Pre-existing condition
Notice of Privacy Practices
(TPA) Third Party Administrator
Deductible
10. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(UCR) Usual - Customary and Reasonable
covered entity
(ERISA) Employee Retirement Income Security Act of 1974
11. 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
electronic media
self-referral
covered entity
Confidential communication
12. 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.
(DME) Durable Medical Equipment
preauthorization
abuse
Notice of Privacy Practices
13. 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
Privacy officer
phantom billing
Assignment & Authorization
epo
14. Is a provider who sends the patients for testing or treatment
attending physician
Network
(ERISA) Employee Retirement Income Security Act of 1974
referring physician
15. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
ethics
abuse
Beneficiary
16. 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
state preemption
ethics
(POS) Point-of Service Plan
nonprivileged information
17. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(COBRA)
(EPO) Exclusive Provider Organization
pcp
18. A structure for classifying outpatient services and procedures for purpose of payment
(Non-par) Non-Participating Provider
Notice of Privacy Practices
Assignment & Authorization
(APC) Ambulatory Patient Classifications
19. A rule - condition - or requirement
Deductible
Standard
(COB) Coordination of Benefits
(DME) Durable Medical Equipment
20. A privileged communication that may be disclosed only with the patient's permission.
Medigap Insurance
Confidential communication
(PPS) Hospital Impatient Prospective Payment System
disclosure
21. The period of time that payment for Medicare inpatient hospital benefits are available
confidentiality
disclosure
benefit period
IIHI
22. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
prepaid plan
clearinghouse
abuse
referring physician
23. 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
AMA
Notice of Privacy Practices
security officer
Pre-existing Condition Exclusion
24. 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
Consent form
epo
authorization form
etiquette
25. 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
authorization form
subscriber
electronic media
Open Enrollment
26. 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
(Non-par) Non-Participating Provider
referring physician
referral
self-referral
27. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(PPS) Hospital Impatient Prospective Payment System
(EPO) Exclusive Provider Organization
abuse
Amblatory Care
28. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
authorization form
Privacy officer
Individually identifiable health information
Pre-existing Condition Exclusion
29. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Claim
ordering physician
Deductible
covered entity
30. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Allowed Expenses
Allowed Expenses
Network
(ERISA) Employee Retirement Income Security Act of 1974
31. Medical staff member who is legally responsible for the care and treatment given to a patient.
premium
complience plan
referring physician
attending physician
32. 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
Pre-existing Condition Exclusion
Deductible
Maximum Out Of Pocket
Sub-acute Care
33. Health Information Portability and Accountability Act
(PAC) Pre- Admission Certification
Claim
HIPAA
Protected health information
34. 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
Open Enrollment
Security Rule
transaction
complience
35. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
privacy
Claim
ppo
(OOPs) Out of Pocket Costs/Expenses
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
hmo
transaction
breach of confidential communication
Referral
37. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Pre-existing Condition Exclusion
complience plan
ordering physician
38. 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
security officer
breach of confidential communication
39. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
(ABN) Advance Beneficiary Notice
Individually identifiable health information
referral
40. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
claim
(COBRA)
phantom billing
41. 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
(PPS) Hospital Impatient Prospective Payment System
cash flow
Pre-existing Condition Exclusion
state preemption
42. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
claim
pos
Medigap Insurance
disclosure
43. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
Out of Network (OON)
Individually identifiable health information
(DRG's)
self-referral
44. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
electronic media
Resonable Charge
closed panel HMO
Pre-existing Condition Exclusion
45. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Standard
self-referral
(EPO) Exclusive Provider Organization
complience plan
46. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
consulting physician
Pre-existing Condition Exclusion
referral
(UR) Utilization review
47. The maximum amount a plan pays for a covered service
Standard
Allowed Expenses
consent
authorization form
48. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
ppo
Supplementary Medical Insurance
(DME) Durable Medical Equipment
49. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
complience plan
Specialist
referring physician
(OOPs) Out of Pocket Costs/Expenses
50. A provision that apples when a person is covered under more than one group medical program
Assignment & Authorization
(COB) Coordination of Benefits
pos
Specialist