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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. Standards of conduct generally accepted as a moral guide for behavior.
Notice of Privacy Practices
pos
consulting physician
ethics
2. 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
abuse
Protected health information
(DOS) Date of Service
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
crossover claim
(ABN) Advance Beneficiary Notice
(Non-par) Non-Participating Provider
ordering physician
4. 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
etiquette
AMA
Referral
econdary Payer
5. American Medical Association
Claim
crossover claim
AMA
cash flow
6. 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.
Privacy officer
Beneficiary
(PAC) Pre- Admission Certification
Embezzlement
7. Is the provider who renders a service to a patient
ppo
Treating or performing physician
ee schedule
crossover claim
8. 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
privacy
Deductible
(COBRA)
epo
9. A patient claim is eligible for medicare and medicaid
etiquette
Protected health information
crossover claim
Privacy officer
10. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
HIPAA
(EPO) Exclusive Provider Organization
Claim
crossover claim
11. 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
transaction
(PAC) Pre- Admission Certification
Embezzlement
(DME) Durable Medical Equipment
12. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
clearinghouse
ordering physician
Standard
complience plan
13. A list of the amount to be paid by an insurance company for each procedure service
(PEC) Pre-existing condition
medical foundation
ee schedule
complience
14. 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
(POS) Point-of Service Plan
consent
Allowed Expenses
covered entity
15. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Assignment & Authorization
e-health information management
(TPA) Third Party Administrator
Experimental Procedures
16. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
subscriber
(UR) Utilization review
AMA
(EPO) Exclusive Provider Organization
17. 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
authorization form
ethics
open panel HMO
disclosure
18. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
Beneficiary
(ERISA) Employee Retirement Income Security Act of 1974
Notice of Privacy Practices
19. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
e-health information management
hmo
Treating or performing physician
epo
20. What the insurance company will consider paying for as defined in the contract.
electronic media
health care provider
ids
Covered Expenses
21. A monthly fee paid by the insured for specific medical insurance coverage
abuse
(TPA) Third Party Administrator
premium
claim
22. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
(EPO) Exclusive Provider Organization
Preauthorization
prepaid plan
electronic media
23. The amount of actual money available to the medical practice
open panel HMO
cash flow
phantom billing
(PPS) Hospital Impatient Prospective Payment System
24. An intentional misrepresentation of the facts to deceive or mislead another.
ee schedule
preauthorization
fraud
Pre-existing Condition Exclusion
25. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
(UCR) Usual - Customary and Reasonable
deductible
fraud
26. 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.
phantom billing
security officer
(ABN) Advance Beneficiary Notice
Consent form
27. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
(APC) Ambulatory Patient Classifications
claim
Pre-certification
28. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
claim
premium
complience plan
transaction
29. A rule - condition - or requirement
Standard
preauthorization
privacy
HIPAA
30. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
closed panel HMO
Specialist
(POS) Point-of Service Plan
electronic media
31. 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
Notice of Privacy Practices
fraud
(ABN) Advance Beneficiary Notice
preauthorization
32. The condition of being secluded from the presence or view of others.
business associate
(DCI) Duplicate Coverage Inquiry
privacy
covered entity
33. American Medical Association
prepaid plan
nonprivileged information
Medigap Insurance
AMA
34. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Standard
Claim
econdary Payer
Resonable Charge
35. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
IIHI
Assignment & Authorization
electronic media
subscriber
36. 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
self-referral
Pre-existing Condition Exclusion
Specialist
abuse
37. The maximum amount a plan pays for a covered service
covered entity
premium
Allowed Expenses
clearinghouse
38. A rule - condition - or requirement
pos
(PCN) Primary Care Network
Standard
(DME) Durable Medical Equipment
39. 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
deductible
ethics
Participating Provider
ids
40. An organization of provider sites with a contracted relationship that offer services
Protected health information
ids
confidentiality
Privileged information
41. Individually identifiable health information
(UR) Utilization review
IIHI
Preauthorization
transaction
42. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(EPO) Exclusive Provider Organization
Medigap Insurance
Individually identifiable health information
(ERISA) Employee Retirement Income Security Act of 1974
43. Is the provider who renders a service to a patient
Treating or performing physician
Covered Expenses
complience
consulting physician
44. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
(DME) Durable Medical Equipment
Standard
business associate
45. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
ethics
referral
security officer
Amblatory Care
46. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
premium
(POS) Point-of Service Plan
(DCI) Duplicate Coverage Inquiry
47. 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-certification
cash flow
(OOPs) Out of Pocket Costs/Expenses
48. 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
Open Enrollment
(PCP) Primary Care Physician
cash flow
Notice of Privacy Practices
49. 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.
fraud
Out of Network (OON)
Protected health information
open panel HMO
50. 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.
complience
Embezzlement
business associate
consent