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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. An organization of provider sites with a contracted relationship that offer services
ids
(DRG's)
(UCR) Usual - Customary and Reasonable
(ABN) Advance Beneficiary Notice
2. Unauthorized release of information
(PCN) Primary Care Network
e-health information management
(PCN) Primary Care Network
breach of confidential communication
3. 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
premium
epo
Pre-existing Condition Exclusion
complience
4. A health insurance enrollee chooses to see an out of network provider without authorization
Referral
preauthorization
(COB) Coordination of Benefits
self-referral
5. A clinic that is owned by the HMO and the physicians are employees of the HMO
econdary Payer
(COB) Coordination of Benefits
(DCI) Duplicate Coverage Inquiry
closed panel HMO
6. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(PAC) Pre- Admission Certification
confidentiality
referring physician
preauthorization
7. American Medical Association
Privileged information
econdary Payer
cash flow
AMA
8. 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
(POS) Point-of Service Plan
Network
benefit period
Supplementary Medical Insurance
9. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(UR) Utilization review
(OOPs) Out of Pocket Costs/Expenses
Medigap Insurance
Referral
10. The maximum amount a plan pays for a covered service
Specialist
health care provider
Allowed Expenses
crossover claim
11. A rule - condition - or requirement
Standard
complience
Protected health information
preauthorization
12. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
Pre-certification
claim
health care provider
Experimental Procedures
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
Assignment & Authorization
pos
(PPS) Hospital Impatient Prospective Payment System
(PAC) Pre- Admission Certification
14. Is a provider who sends the patients for testing or treatment
(PPS) Hospital Impatient Prospective Payment System
ordering physician
Referral
referring physician
15. 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
Beneficiary
nonprivileged information
covered entity
(TPA) Third Party Administrator
16. 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
Preauthorization
Pre-existing Condition Exclusion
etiquette
consulting physician
17. Integrating benefits payable under more than one health insurance.
Standard
Confidential communication
Coordinated Coverage
Individually identifiable health information
18. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Consent form
Pre-certification
(OOPs) Out of Pocket Costs/Expenses
hmo
19. 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
pos
(UCR) Usual - Customary and Reasonable
AMA
20. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Treating or performing physician
Referral
(POS) Point-of Service Plan
pcp
21. Billing for services not performed
Amblatory Care
pos
deductible
phantom billing
22. Individually identifiable health information
Individually identifiable health information
IIHI
Maximum Out Of Pocket
closed panel HMO
23. The condition of being secluded from the presence or view of others.
econdary Payer
clearinghouse
(COBRA)
privacy
24. 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)
breach of confidential communication
Network
Consent form
electronic media
25. A review of the need for inpatient hospital care - completed before the actual admission
(ABN) Advance Beneficiary Notice
medical foundation
(PAC) Pre- Admission Certification
etiquette
26. American Medical Association
etiquette
e-health information management
prepaid plan
AMA
27. 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
Treating or performing physician
referral
authorization form
disclosure
28. 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
Embezzlement
confidentiality
Network
Maximum Out Of Pocket
29. 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
Open Enrollment
complience plan
(COBRA)
Pre-certification
30. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
covered entity
consulting physician
deductible
Pre-certification
31. A structure for classifying outpatient services and procedures for purpose of payment
Specialist
premium
crossover claim
(APC) Ambulatory Patient Classifications
32. 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
disclosure
Standard
benefit period
33. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
claim
Consent form
(DCI) Duplicate Coverage Inquiry
ids
34. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
disclosure
Pre-certification
(DOS) Date of Service
35. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(DRG's)
preauthorization
transaction
e-health information management
36. 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
Amblatory Care
Network
pos
(PCP) Primary Care Physician
37. 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
Standard
Security Rule
(COBRA)
(ERISA) Employee Retirement Income Security Act of 1974
38. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
electronic media
(DRG's)
complience
referral
39. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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40. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
ids
Pre-existing Condition Exclusion
authorization form
(UR) Utilization review
41. 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
Open Enrollment
pcp
open panel HMO
claim
42. Is the provider who renders a service to a patient
Treating or performing physician
Pre-existing Condition Exclusion
preauthorization
ids
43. The dates of healthcare services were provided to the beneficiary
security officer
health care provider
Maximum Out Of Pocket
(DOS) Date of Service
44. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Standard
(UCR) Usual - Customary and Reasonable
ppo
Allowed Expenses
45. 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
(EPO) Exclusive Provider Organization
Preauthorization
privacy
business associate
46. What the insurance company will consider paying for as defined in the contract.
complience
pcp
breach of confidential communication
Covered Expenses
47. Unauthorized release of information
breach of confidential communication
(DME) Durable Medical Equipment
Experimental Procedures
Embezzlement
48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(PCP) Primary Care Physician
abuse
Sub-acute Care
e-health information management
49. 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
(ERISA) Employee Retirement Income Security Act of 1974
medical foundation
referring physician
ppo
50. The period of time that payment for Medicare inpatient hospital benefits are available
breach of confidential communication
benefit period
Protected health information
ids