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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. 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
health care provider
covered entity
2. A nonprofit integrated delivery system
(DME) Durable Medical Equipment
ppo
medical foundation
benefit period
3. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
econdary Payer
consulting physician
e-health information management
referral
4. Individually identifiable health information
IIHI
ids
Standard
(POS) Point-of Service Plan
5. 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
Out of Network (OON)
(PCP) Primary Care Physician
Privacy officer
attending physician
6. 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
IIHI
crossover claim
Preauthorization
Treating or performing physician
7. A structure for classifying outpatient services and procedures for purpose of payment
state preemption
(APC) Ambulatory Patient Classifications
ordering physician
Protected health information
8. 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
Beneficiary
nonprivileged information
Privileged information
authorization form
9. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Coordinated Coverage
(DCI) Duplicate Coverage Inquiry
(OOPs) Out of Pocket Costs/Expenses
(POS) Point-of Service Plan
10. Medicare's method of paying acute care hospitals for inpatient care
privacy
(PPS) Hospital Impatient Prospective Payment System
Resonable Charge
fraud
11. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(AOB) Assignment of Benefits
Amblatory Care
electronic media
Confidential communication
12. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
Maximum Out Of Pocket
Privileged information
Open Enrollment
subscriber
13. 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.
pcp
health care provider
IIHI
fraud
14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(POS) Point-of Service Plan
Security Rule
consulting physician
(OOPs) Out of Pocket Costs/Expenses
15. 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
medical foundation
(AOB) Assignment of Benefits
Supplementary Medical Insurance
(POS) Point-of Service Plan
16. A review of the need for inpatient hospital care - completed before the actual admission
(POS) Point-of Service Plan
breach of confidential communication
Allowed Expenses
(PAC) Pre- Admission Certification
17. Is the provider who renders a service to a patient
Sub-acute Care
Treating or performing physician
Participating Provider
authorization form
18. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
Individually identifiable health information
abuse
Pre-certification
19. What the insurance company will consider paying for as defined in the contract.
Experimental Procedures
Covered Expenses
pos
Coordinated Coverage
20. 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
Network
attending physician
consulting physician
21. 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
(APC) Ambulatory Patient Classifications
Sub-acute Care
self-referral
transaction
22. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
cash flow
complience plan
claim
Individually identifiable health information
23. A list of the amount to be paid by an insurance company for each procedure service
privacy
Coordinated Coverage
ee schedule
complience plan
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. A provision that apples when a person is covered under more than one group medical program
ids
(COB) Coordination of Benefits
prepaid plan
electronic media
26. Verbal or written agreement that gives approval to some action - situation - or statement.
Resonable Charge
consent
Preauthorization
authorization form
27. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
Privileged information
confidentiality
clearinghouse
(UR) Utilization review
28. 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.
deductible
state preemption
(EPO) Exclusive Provider Organization
authorization form
29. 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
(PPS) Hospital Impatient Prospective Payment System
(Non-par) Non-Participating Provider
closed panel HMO
Open Enrollment
30. An organization of provider sites with a contracted relationship that offer services
consent
transaction
ids
AMA
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.
Coordinated Coverage
benefit period
business associate
complience
32. 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
state preemption
Resonable Charge
consent
33. A structure for classifying outpatient services and procedures for purpose of payment
Individually identifiable health information
HIPAA
Network
(APC) Ambulatory Patient Classifications
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
(DCI) Duplicate Coverage Inquiry
(AOB) Assignment of Benefits
phantom billing
confidentiality
35. 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
(PCN) Primary Care Network
Subscriber
Out of Network (OON)
Privacy officer
36. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(COBRA)
(Non-par) Non-Participating Provider
complience plan
consent
37. Someone who is eligible for or receiving benefits under an insurance policy or plan
(ABN) Advance Beneficiary Notice
attending physician
Beneficiary
breach of confidential communication
38. 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
Specialist
covered entity
health care provider
complience plan
39. 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
subscriber
Network
(DME) Durable Medical Equipment
(PCP) Primary Care Physician
40. 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
Maximum Out Of Pocket
HIPAA
Supplementary Medical Insurance
Security Rule
41. Is a provider who sends the patients for testing or treatment
referring physician
business associate
premium
ee schedule
42. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Preauthorization
transaction
hmo
deductible
43. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
Privileged information
complience plan
(COB) Coordination of Benefits
44. Billing for services not performed
Preauthorization
phantom billing
Coordinated Coverage
Medigap Insurance
45. An organization of provider sites with a contracted relationship that offer services
Subscriber
(EPO) Exclusive Provider Organization
HIPAA
ids
46. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
IIHI
Security Rule
self-referral
47. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
referral
subscriber
ethics
breach of confidential communication
48. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
referring physician
ids
(OOPs) Out of Pocket Costs/Expenses
49. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
open panel HMO
ordering physician
Pre-certification
consent
50. Standards of conduct generally accepted as a moral guide for behavior.
phantom billing
(DRG's)
ethics
Consent form