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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. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
deductible
Pre-certification
Pre-existing Condition Exclusion
self-referral
2. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
HIPAA
Specialist
referring physician
Standard
3. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
etiquette
(Non-par) Non-Participating Provider
consent
4. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
referral
(DOS) Date of Service
(UR) Utilization review
5. 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
(ABN) Advance Beneficiary Notice
(PCN) Primary Care Network
prepaid plan
6. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
premium
Assignment & Authorization
e-health information management
state preemption
7. A patient claim is eligible for medicare and medicaid
(PEC) Pre-existing condition
crossover claim
Pre-certification
Preauthorization
8. A health insurance enrollee chooses to see an out of network provider without authorization
HIPAA
(APC) Ambulatory Patient Classifications
self-referral
abuse
9. 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
abuse
complience
e-health information management
Preauthorization
10. 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.
(COB) Coordination of Benefits
Protected health information
(DCI) Duplicate Coverage Inquiry
disclosure
11. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
ethics
Medigap Insurance
deductible
Specialist
12. Unauthorized release of information
referral
breach of confidential communication
Pre-certification
(OOPs) Out of Pocket Costs/Expenses
13. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
(TPA) Third Party Administrator
abuse
Individually identifiable health information
14. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
complience plan
preauthorization
open panel HMO
(COBRA)
15. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
state preemption
AMA
pos
Medigap Insurance
16. 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
abuse
health care provider
Out of Network (OON)
17. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
HIPAA
preauthorization
Beneficiary
ee schedule
18. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
(POS) Point-of Service Plan
(Non-par) Non-Participating Provider
econdary Payer
(PAC) Pre- Admission Certification
19. 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
Confidential communication
pos
security officer
20. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.
health care provider
Referral
epo
medical foundation
21. 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
AMA
(AOB) Assignment of Benefits
cash flow
22. 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
(DME) Durable Medical Equipment
covered entity
Subscriber
Out of Network (OON)
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
Pre-certification
complience plan
Consent form
Pre-existing Condition Exclusion
24. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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25. American Medical Association
abuse
AMA
cash flow
covered entity
26. Standards of conduct generally accepted as a moral guide for behavior.
Protected health information
hmo
ethics
closed panel HMO
27. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
(POS) Point-of Service Plan
cash flow
Coordinated Coverage
28. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
(Non-par) Non-Participating Provider
HIPAA
complience
29. 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
covered entity
(DCI) Duplicate Coverage Inquiry
(COBRA)
30. A structure for classifying outpatient services and procedures for purpose of payment
Open Enrollment
(TPA) Third Party Administrator
ppo
(APC) Ambulatory Patient Classifications
31. 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
Claim
disclosure
Amblatory Care
32. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(Non-par) Non-Participating Provider
clearinghouse
(Non-par) Non-Participating Provider
complience
33. Billing for services not performed
Privileged information
AMA
(DCI) Duplicate Coverage Inquiry
phantom billing
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
Covered Expenses
(OOPs) Out of Pocket Costs/Expenses
(AOB) Assignment of Benefits
Security Rule
35. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
consulting physician
e-health information management
IIHI
medical foundation
36. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Confidential communication
Notice of Privacy Practices
disclosure
37. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
confidentiality
Subscriber
(PCN) Primary Care Network
Experimental Procedures
38. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(ABN) Advance Beneficiary Notice
benefit period
health care provider
39. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
deductible
Embezzlement
Resonable Charge
electronic media
40. 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
Beneficiary
AMA
(Non-par) Non-Participating Provider
Deductible
41. 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
Protected health information
Subscriber
Protected health information
Assignment & Authorization
42. 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
confidentiality
(ABN) Advance Beneficiary Notice
state preemption
(DOS) Date of Service
43. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
referral
Supplementary Medical Insurance
Individually identifiable health information
(PAC) Pre- Admission Certification
44. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
deductible
Individually identifiable health information
Preauthorization
Confidential communication
45. 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
(ABN) Advance Beneficiary Notice
(DME) Durable Medical Equipment
(COB) Coordination of Benefits
covered entity
46. A monthly fee paid by the insured for specific medical insurance coverage
transaction
(AOB) Assignment of Benefits
premium
(PCN) Primary Care Network
47. The maximum amount a plan pays for a covered service
Allowed Expenses
ordering physician
Claim
(ABN) Advance Beneficiary Notice
48. 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
(COBRA)
(PAC) Pre- Admission Certification
referral
Individually identifiable health information
49. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
Standard
(PCN) Primary Care Network
Preauthorization
Privileged information
50. Medical services provided on an outpatient basis
electronic media
Amblatory Care
phantom billing
deductible