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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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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. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Open Enrollment
Claim
Security Rule
Standard
2. A structure for classifying outpatient services and procedures for purpose of payment
(Non-par) Non-Participating Provider
(APC) Ambulatory Patient Classifications
referring physician
(ERISA) Employee Retirement Income Security Act of 1974
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
(POS) Point-of Service Plan
Protected health information
HIPAA
ids
4. Verbal or written agreement that gives approval to some action - situation - or statement.
nonprivileged information
consent
complience plan
self-referral
5. 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
Security Rule
Amblatory Care
(ABN) Advance Beneficiary Notice
Out of Network (OON)
6. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
epo
claim
consulting physician
(DME) Durable Medical Equipment
7. The dates of healthcare services were provided to the beneficiary
(Non-par) Non-Participating Provider
confidentiality
(DOS) Date of Service
breach of confidential communication
8. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
consulting physician
subscriber
Coordinated Coverage
AMA
9. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
state preemption
nonprivileged information
Pre-certification
10. 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
Amblatory Care
fraud
Protected health information
11. A review of the need for inpatient hospital care - completed before the actual admission
(EPO) Exclusive Provider Organization
(PAC) Pre- Admission Certification
(DME) Durable Medical Equipment
(ERISA) Employee Retirement Income Security Act of 1974
12. 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
(PEC) Pre-existing condition
(EPO) Exclusive Provider Organization
Assignment & Authorization
ppo
13. 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
Assignment & Authorization
Preauthorization
Privacy officer
open panel HMO
14. 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.
Protected health information
(Non-par) Non-Participating Provider
Deductible
abuse
15. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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16. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Deductible
complience
(UR) Utilization review
Medigap Insurance
17. 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
Supplementary Medical Insurance
complience
(PCN) Primary Care Network
nonprivileged information
18. A privileged communication that may be disclosed only with the patient's permission.
HIPAA
security officer
Confidential communication
medical foundation
19. 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
nonprivileged information
Embezzlement
pos
econdary Payer
20. 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
(DCI) Duplicate Coverage Inquiry
(APC) Ambulatory Patient Classifications
(TPA) Third Party Administrator
21. 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
Protected health information
(ERISA) Employee Retirement Income Security Act of 1974
medical foundation
state preemption
22. 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.
(DRG's)
(TPA) Third Party Administrator
business associate
Resonable Charge
23. The maximum amount a plan pays for a covered service
(DOS) Date of Service
(PCP) Primary Care Physician
Allowed Expenses
Pre-existing Condition Exclusion
24. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Network
(DME) Durable Medical Equipment
disclosure
authorization form
25. 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
open panel HMO
(Non-par) Non-Participating Provider
subscriber
(AOB) Assignment of Benefits
26. 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
epo
Participating Provider
Preauthorization
(EPO) Exclusive Provider Organization
27. Health Information Portability and Accountability Act
Amblatory Care
HIPAA
(DCI) Duplicate Coverage Inquiry
Resonable Charge
28. A nonprofit integrated delivery system
Medigap Insurance
(AOB) Assignment of Benefits
pos
medical foundation
29. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
crossover claim
Sub-acute Care
security officer
30. 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.
Notice of Privacy Practices
security officer
Treating or performing physician
econdary Payer
31. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Out of Network (OON)
(COBRA)
(PEC) Pre-existing condition
(DCI) Duplicate Coverage Inquiry
32. 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
state preemption
Standard
Experimental Procedures
(AOB) Assignment of Benefits
33. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
claim
(UCR) Usual - Customary and Reasonable
Out of Network (OON)
Maximum Out Of Pocket
34. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Consent form
econdary Payer
preauthorization
Deductible
35. 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
Supplementary Medical Insurance
(ERISA) Employee Retirement Income Security Act of 1974
(POS) Point-of Service Plan
Consent form
36. Is the provider who renders a service to a patient
Allowed Expenses
Privacy officer
Treating or performing physician
clearinghouse
37. 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
Privacy officer
phantom billing
(COBRA)
Pre-certification
38. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
pcp
e-health information management
clearinghouse
epo
39. 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
(AOB) Assignment of Benefits
ee schedule
abuse
referral
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.
Notice of Privacy Practices
covered entity
confidentiality
closed panel HMO
41. A health insurance enrollee chooses to see an out of network provider without authorization
HIPAA
subscriber
self-referral
benefit period
42. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Open Enrollment
Consent form
(UCR) Usual - Customary and Reasonable
(POS) Point-of Service Plan
43. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
premium
(PPS) Hospital Impatient Prospective Payment System
medical foundation
abuse
44. Unauthorized release of information
state preemption
(Non-par) Non-Participating Provider
breach of confidential communication
ids
45. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Covered Expenses
covered entity
(COB) Coordination of Benefits
46. 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
Supplementary Medical Insurance
Coordinated Coverage
ppo
(ABN) Advance Beneficiary Notice
47. An organization of provider sites with a contracted relationship that offer services
ids
cash flow
Standard
IIHI
48. 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)
Consent form
complience plan
health care provider
(APC) Ambulatory Patient Classifications
49. An organization of provider sites with a contracted relationship that offer services
Open Enrollment
Preauthorization
IIHI
ids
50. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
covered entity
(POS) Point-of Service Plan
pcp