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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. The amount of actual money available to the medical practice
Beneficiary
electronic media
ordering physician
cash flow
2. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(PEC) Pre-existing condition
benefit period
ordering physician
(DRG's)
3. 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
Specialist
Out of Network (OON)
business associate
Participating Provider
4. Is a provider who sends the patients for testing or treatment
Embezzlement
claim
referring physician
Amblatory Care
5. 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
Pre-existing Condition Exclusion
abuse
complience plan
ppo
6. A review of the need for inpatient hospital care - completed before the actual admission
Medigap Insurance
(PAC) Pre- Admission Certification
(PCN) Primary Care Network
(DRG's)
7. Unauthorized release of information
pos
breach of confidential communication
ordering physician
Specialist
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 privileged communication that may be disclosed only with the patient's permission.
security officer
Network
Confidential communication
Pre-existing Condition Exclusion
10. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
phantom billing
Privileged information
prepaid plan
state preemption
11. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
hmo
Individually identifiable health information
ordering physician
self-referral
12. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
(UR) Utilization review
Supplementary Medical Insurance
(Non-par) Non-Participating Provider
13. 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
covered entity
(ABN) Advance Beneficiary Notice
clearinghouse
Deductible
14. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Beneficiary
Notice of Privacy Practices
complience
Supplementary Medical Insurance
15. A health insurance enrollee chooses to see an out of network provider without authorization
(PPS) Hospital Impatient Prospective Payment System
Confidential communication
self-referral
(Non-par) Non-Participating Provider
16. 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.
Assignment & Authorization
Protected health information
Referral
Specialist
17. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
health care provider
ids
(PEC) Pre-existing condition
18. A list of the amount to be paid by an insurance company for each procedure service
IIHI
prepaid plan
(UR) Utilization review
ee schedule
19. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
epo
security officer
fraud
20. 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
ordering physician
Open Enrollment
(PCN) Primary Care Network
(ERISA) Employee Retirement Income Security Act of 1974
21. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
IIHI
Subscriber
(AOB) Assignment of Benefits
premium
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
Participating Provider
Deductible
pos
benefit period
23. A patient claim is eligible for medicare and medicaid
crossover claim
(ABN) Advance Beneficiary Notice
complience plan
(PCP) Primary Care Physician
24. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
referral
epo
Resonable Charge
(UR) Utilization review
25. 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
AMA
e-health information management
authorization form
(PAC) Pre- Admission Certification
26. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
(UCR) Usual - Customary and Reasonable
health care provider
Privileged information
27. A clinic that is owned by the HMO and the physicians are employees of the HMO
preauthorization
closed panel HMO
claim
(OOPs) Out of Pocket Costs/Expenses
28. Individually identifiable health information
(DRG's)
IIHI
preauthorization
(DME) Durable Medical Equipment
29. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Deductible
complience
Preauthorization
30. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
Beneficiary
business associate
ordering physician
31. 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
Deductible
Resonable Charge
subscriber
32. 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
covered entity
Pre-existing Condition Exclusion
nonprivileged information
33. 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)
abuse
(PPS) Hospital Impatient Prospective Payment System
Consent form
nonprivileged information
34. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Supplementary Medical Insurance
Allowed Expenses
preauthorization
complience
35. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
premium
Embezzlement
pcp
consent
36. A rule - condition - or requirement
Standard
preauthorization
state preemption
ids
37. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Resonable Charge
Preauthorization
deductible
phantom billing
38. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
referring physician
hmo
prepaid plan
consulting physician
39. The maximum amount a plan pays for a covered service
Allowed Expenses
subscriber
(DCI) Duplicate Coverage Inquiry
(UR) Utilization review
40. 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
Notice of Privacy Practices
pcp
premium
(COBRA)
41. An organization of provider sites with a contracted relationship that offer services
prepaid plan
complience plan
ids
attending physician
42. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
ee schedule
Pre-existing Condition Exclusion
(PCN) Primary Care Network
disclosure
43. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
complience plan
Embezzlement
(PEC) Pre-existing condition
44. 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.
Amblatory Care
Individually identifiable health information
security officer
(DRG's)
45. A provision that apples when a person is covered under more than one group medical program
AMA
preauthorization
Notice of Privacy Practices
(COB) Coordination of Benefits
46. 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
econdary Payer
breach of confidential communication
IIHI
47. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Open Enrollment
abuse
Coordinated Coverage
Network
48. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
crossover claim
(EPO) Exclusive Provider Organization
Covered Expenses
49. A nonprofit integrated delivery system
medical foundation
AMA
(DRG's)
HIPAA
50. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
(Non-par) Non-Participating Provider
preauthorization
Maximum Out Of Pocket