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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.
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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. 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)
Security Rule
referring physician
Individually identifiable health information
2. 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
medical foundation
Experimental Procedures
security officer
open panel HMO
3. 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
security officer
state preemption
(Non-par) Non-Participating Provider
Deductible
4. 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
Beneficiary
subscriber
(COB) Coordination of Benefits
(PCP) Primary Care Physician
5. 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.
ethics
Notice of Privacy Practices
abuse
pos
6. 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
Supplementary Medical Insurance
attending physician
AMA
Open Enrollment
7. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
ppo
(EPO) Exclusive Provider Organization
(DRG's)
8. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Preauthorization
epo
ids
complience
9. 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)
covered entity
Notice of Privacy Practices
Consent form
Privileged information
10. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Pre-existing Condition Exclusion
hmo
self-referral
prepaid plan
11. 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
Out of Network (OON)
pos
Specialist
covered entity
12. The dates of healthcare services were provided to the beneficiary
complience
(DOS) Date of Service
premium
Standard
13. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
(EPO) Exclusive Provider Organization
consent
epo
14. Standards of conduct generally accepted as a moral guide for behavior.
open panel HMO
(DCI) Duplicate Coverage Inquiry
ethics
Deductible
15. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
attending physician
Supplementary Medical Insurance
AMA
(TPA) Third Party Administrator
16. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(DME) Durable Medical Equipment
deductible
(APC) Ambulatory Patient Classifications
17. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Pre-existing Condition Exclusion
hmo
Sub-acute Care
pcp
18. 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
open panel HMO
Claim
Individually identifiable health information
(DCI) Duplicate Coverage Inquiry
19. 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
Supplementary Medical Insurance
etiquette
cash flow
20. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
cash flow
Sub-acute Care
crossover claim
21. 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
Protected health information
electronic media
Claim
22. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
Medigap Insurance
Treating or performing physician
complience plan
23. 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
Experimental Procedures
pos
Privacy officer
Sub-acute Care
24. The maximum amount a plan pays for a covered service
(APC) Ambulatory Patient Classifications
fraud
Allowed Expenses
Embezzlement
25. 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.
(PAC) Pre- Admission Certification
Pre-certification
Amblatory Care
Notice of Privacy Practices
26. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
nonprivileged information
Privileged information
Allowed Expenses
27. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou
epo
Sub-acute Care
Experimental Procedures
hmo
28. A monthly fee paid by the insured for specific medical insurance coverage
(OOPs) Out of Pocket Costs/Expenses
hmo
premium
authorization form
29. 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
Embezzlement
attending physician
(TPA) Third Party Administrator
30. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Assignment & Authorization
(PAC) Pre- Admission Certification
Sub-acute Care
31. 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
Pre-certification
consent
Participating Provider
Confidential communication
32. Health Information Portability and Accountability Act
HIPAA
Privileged information
privacy
AMA
33. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
ids
covered entity
subscriber
nonprivileged information
34. Customs - rules of conduct - courtesy - and manners of the medical profession
business associate
breach of confidential communication
etiquette
(POS) Point-of Service Plan
35. Is a provider who sends the patients for testing or treatment
breach of confidential communication
etiquette
referring physician
Consent form
36. The period of time that payment for Medicare inpatient hospital benefits are available
epo
Standard
benefit period
ids
37. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
self-referral
(OOPs) Out of Pocket Costs/Expenses
claim
Claim
38. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
e-health information management
Confidential communication
electronic media
(OOPs) Out of Pocket Costs/Expenses
39. 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
ordering physician
Maximum Out Of Pocket
clearinghouse
(ERISA) Employee Retirement Income Security Act of 1974
40. A structure for classifying outpatient services and procedures for purpose of payment
covered entity
electronic media
(DOS) Date of Service
(APC) Ambulatory Patient Classifications
41. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
clearinghouse
(Non-par) Non-Participating Provider
electronic media
privacy
42. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
clearinghouse
HIPAA
(ERISA) Employee Retirement Income Security Act of 1974
preauthorization
43. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
claim
security officer
(DCI) Duplicate Coverage Inquiry
44. A privileged communication that may be disclosed only with the patient's permission.
IIHI
Open Enrollment
Individually identifiable health information
Confidential communication
45. 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
(ABN) Advance Beneficiary Notice
Pre-existing Condition Exclusion
Assignment & Authorization
(COB) Coordination of Benefits
46. 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
(DRG's)
(PCP) Primary Care Physician
transaction
pcp
47. Medical services provided on an outpatient basis
covered entity
Amblatory Care
(PAC) Pre- Admission Certification
ordering physician
48. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
AMA
(UCR) Usual - Customary and Reasonable
(PCN) Primary Care Network
Individually identifiable health information
49. 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
(AOB) Assignment of Benefits
fraud
Specialist
50. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
fraud
(UR) Utilization review
consulting physician
Network