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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. Unauthorized release of information
(APC) Ambulatory Patient Classifications
breach of confidential communication
(POS) Point-of Service Plan
(APC) Ambulatory Patient Classifications
2. Is a provider who sends the patients for testing or treatment
Coordinated Coverage
complience plan
referring physician
(DCI) Duplicate Coverage Inquiry
3. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
state preemption
(UCR) Usual - Customary and Reasonable
self-referral
(OOPs) Out of Pocket Costs/Expenses
4. Billing for services not performed
complience plan
(DCI) Duplicate Coverage Inquiry
(EPO) Exclusive Provider Organization
phantom billing
5. 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
epo
(PCP) Primary Care Physician
open panel HMO
security officer
6. 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
Specialist
health care provider
(DOS) Date of Service
covered entity
7. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Privacy officer
(UCR) Usual - Customary and Reasonable
Network
Confidential communication
8. 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
ids
(DRG's)
Participating Provider
(TPA) Third Party Administrator
9. Standards of conduct generally accepted as a moral guide for behavior.
ethics
(COBRA)
HIPAA
HIPAA
10. 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
Beneficiary
e-health information management
prepaid plan
11. Someone who is eligible for or receiving benefits under an insurance policy or plan
(TPA) Third Party Administrator
Coordinated Coverage
Beneficiary
security officer
12. 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
pos
(PPS) Hospital Impatient Prospective Payment System
referring physician
open panel HMO
13. A willful act by an employee of taking possession of an employer's money
transaction
Embezzlement
Open Enrollment
(DCI) Duplicate Coverage Inquiry
14. 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
Assignment & Authorization
Maximum Out Of Pocket
Privacy officer
Network
15. A rule - condition - or requirement
Standard
(ERISA) Employee Retirement Income Security Act of 1974
clearinghouse
privacy
16. 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
Maximum Out Of Pocket
(ERISA) Employee Retirement Income Security Act of 1974
fraud
(TPA) Third Party Administrator
17. 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.
Confidential communication
Notice of Privacy Practices
ids
Medigap Insurance
18. 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
benefit period
(AOB) Assignment of Benefits
Participating Provider
econdary Payer
19. Individually identifiable health information
IIHI
Pre-existing Condition Exclusion
claim
Embezzlement
20. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(UR) Utilization review
cash flow
referring physician
ordering physician
21. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
(UR) Utilization review
Standard
preauthorization
22. 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
Supplementary Medical Insurance
deductible
AMA
claim
23. A willful act by an employee of taking possession of an employer's money
(APC) Ambulatory Patient Classifications
state preemption
Embezzlement
ethics
24. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
health care provider
Specialist
closed panel HMO
25. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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26. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(OOPs) Out of Pocket Costs/Expenses
Claim
closed panel HMO
referral
27. 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.
Notice of Privacy Practices
Amblatory Care
(POS) Point-of Service Plan
Privacy officer
28. A patient claim is eligible for medicare and medicaid
Beneficiary
crossover claim
Allowed Expenses
claim
29. Customs - rules of conduct - courtesy - and manners of the medical profession
Referral
health care provider
etiquette
(UR) Utilization review
30. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
clearinghouse
Pre-existing Condition Exclusion
transaction
31. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
hmo
(ABN) Advance Beneficiary Notice
Claim
32. A review of the need for inpatient hospital care - completed before the actual admission
fraud
ppo
ordering physician
(PAC) Pre- Admission Certification
33. Integrating benefits payable under more than one health insurance.
Protected health information
Embezzlement
Coordinated Coverage
(AOB) Assignment of Benefits
34. 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
ppo
Deductible
(PCN) Primary Care Network
benefit period
35. 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
Coordinated Coverage
consulting physician
Deductible
pos
36. 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.
Embezzlement
Notice of Privacy Practices
Privacy officer
(OOPs) Out of Pocket Costs/Expenses
37. A patient claim is eligible for medicare and medicaid
prepaid plan
Allowed Expenses
covered entity
crossover claim
38. 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
consent
(AOB) Assignment of Benefits
pos
business associate
39. 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
Covered Expenses
cash flow
(ABN) Advance Beneficiary Notice
ordering physician
40. Is the provider who renders a service to a patient
Treating or performing physician
(PCN) Primary Care Network
claim
Covered Expenses
41. The period of time that payment for Medicare inpatient hospital benefits are available
ids
cash flow
IIHI
benefit period
42. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
referring physician
Claim
Embezzlement
Maximum Out Of Pocket
43. 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
prepaid plan
Amblatory Care
pos
nonprivileged information
44. Approval or consent by a primary physician for patient referral to ancillary services and specialists
e-health information management
attending physician
Referral
Coordinated Coverage
45. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(COBRA)
Resonable Charge
premium
(PPS) Hospital Impatient Prospective Payment System
46. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Coordinated Coverage
confidentiality
clearinghouse
47. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
electronic media
HIPAA
disclosure
(DCI) Duplicate Coverage Inquiry
48. 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
ppo
crossover claim
referring physician
Beneficiary
49. 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
security officer
disclosure
(DME) Durable Medical Equipment
Amblatory Care
50. 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
IIHI
(AOB) Assignment of Benefits
Preauthorization
Participating Provider