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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. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
closed panel HMO
health care provider
state preemption
2. Verbal or written agreement that gives approval to some action - situation - or statement.
(TPA) Third Party Administrator
consent
etiquette
Open Enrollment
3. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(DCI) Duplicate Coverage Inquiry
Referral
Preauthorization
(PAC) Pre- Admission Certification
4. Verbal or written agreement that gives approval to some action - situation - or statement.
covered entity
Notice of Privacy Practices
(PCP) Primary Care Physician
consent
5. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
claim
consulting physician
deductible
(DCI) Duplicate Coverage Inquiry
6. 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
(AOB) Assignment of Benefits
Embezzlement
(COBRA)
ids
7. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
self-referral
complience plan
disclosure
Notice of Privacy Practices
8. 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
HIPAA
Security Rule
premium
(COB) Coordination of Benefits
9. 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
Network
Assignment & Authorization
ppo
AMA
10. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
consent
(UR) Utilization review
clearinghouse
cash flow
11. 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
deductible
benefit period
Assignment & Authorization
Privileged information
12. A health insurance enrollee chooses to see an out of network provider without authorization
(EPO) Exclusive Provider Organization
referral
self-referral
medical foundation
13. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Experimental Procedures
complience plan
Security Rule
breach of confidential communication
14. A rule - condition - or requirement
referring physician
Supplementary Medical Insurance
(TPA) Third Party Administrator
Standard
15. 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
Privileged information
medical foundation
privacy
(ABN) Advance Beneficiary Notice
16. 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.
Out of Network (OON)
(POS) Point-of Service Plan
Privileged information
(PCN) Primary Care Network
17. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
complience
ordering physician
transaction
18. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
closed panel HMO
(DOS) Date of Service
Notice of Privacy Practices
19. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
Deductible
Amblatory Care
breach of confidential communication
20. 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
attending physician
Assignment & Authorization
subscriber
epo
21. 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
Deductible
(DRG's)
authorization form
deductible
22. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
referral
Resonable Charge
transaction
Maximum Out Of Pocket
23. 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
Specialist
fraud
ordering physician
(PCN) Primary Care Network
24. 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.
pcp
consulting physician
state preemption
Subscriber
25. A patient claim is eligible for medicare and medicaid
(PEC) Pre-existing condition
crossover claim
HIPAA
(UCR) Usual - Customary and Reasonable
26. 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
(Non-par) Non-Participating Provider
security officer
Deductible
pos
27. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Covered Expenses
ppo
deductible
(AOB) Assignment of Benefits
28. 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
Security Rule
Preauthorization
Notice of Privacy Practices
Out of Network (OON)
29. 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
pos
business associate
claim
30. A privileged communication that may be disclosed only with the patient's permission.
(AOB) Assignment of Benefits
Confidential communication
(DCI) Duplicate Coverage Inquiry
Claim
31. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
abuse
referral
(DME) Durable Medical Equipment
Covered Expenses
32. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Privacy officer
Referral
Maximum Out Of Pocket
(DOS) Date of Service
33. 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
privacy
Network
pos
34. Medicare's method of paying acute care hospitals for inpatient care
(PAC) Pre- Admission Certification
Resonable Charge
benefit period
(PPS) Hospital Impatient Prospective Payment System
35. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
benefit period
(DRG's)
(UR) Utilization review
36. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Privileged information
phantom billing
Medigap Insurance
crossover claim
37. 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
medical foundation
ethics
Resonable Charge
open panel HMO
38. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
Pre-existing Condition Exclusion
Privileged information
preauthorization
39. Is the provider who renders a service to a patient
(ABN) Advance Beneficiary Notice
(DOS) Date of Service
Privileged information
Treating or performing physician
40. 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
Individually identifiable health information
(OOPs) Out of Pocket Costs/Expenses
health care provider
41. 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.
Consent form
fraud
pos
Privacy officer
42. 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
Coordinated Coverage
(AOB) Assignment of Benefits
(AOB) Assignment of Benefits
Out of Network (OON)
43. 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.
HIPAA
(EPO) Exclusive Provider Organization
health care provider
IIHI
44. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Out of Network (OON)
(ERISA) Employee Retirement Income Security Act of 1974
(TPA) Third Party Administrator
Embezzlement
45. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
attending physician
Confidential communication
(Non-par) Non-Participating Provider
disclosure
46. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(APC) Ambulatory Patient Classifications
Maximum Out Of Pocket
subscriber
Protected health information
47. 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
(DCI) Duplicate Coverage Inquiry
complience plan
consent
Supplementary Medical Insurance
48. Customs - rules of conduct - courtesy - and manners of the medical profession
benefit period
Protected health information
etiquette
(AOB) Assignment of Benefits
49. 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
confidentiality
Standard
Beneficiary
Out of Network (OON)
50. 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
state preemption
(PEC) Pre-existing condition
(COBRA)
(POS) Point-of Service Plan