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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. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
health care provider
security officer
etiquette
2. 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)
Standard
prepaid plan
(UR) Utilization review
3. Integrating benefits payable under more than one health insurance.
Medigap Insurance
Amblatory Care
confidentiality
Coordinated Coverage
4. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Notice of Privacy Practices
Claim
confidentiality
Open Enrollment
5. American Medical Association
health care provider
AMA
Coordinated Coverage
preauthorization
6. A health insurance enrollee chooses to see an out of network provider without authorization
Security Rule
self-referral
econdary Payer
fraud
7. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
consulting physician
referring physician
e-health information management
Maximum Out Of Pocket
8. 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
IIHI
Preauthorization
cash flow
Out of Network (OON)
9. A provision that apples when a person is covered under more than one group medical program
Preauthorization
complience
privacy
(COB) Coordination of Benefits
10. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
health care provider
ordering physician
(PEC) Pre-existing condition
(Non-par) Non-Participating Provider
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
Protected health information
AMA
Out of Network (OON)
(TPA) Third Party Administrator
12. 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
(PCP) Primary Care Physician
crossover claim
Amblatory Care
Deductible
13. Unauthorized release of information
Security Rule
(DME) Durable Medical Equipment
breach of confidential communication
ee schedule
14. 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
Pre-existing Condition Exclusion
Participating Provider
consulting physician
15. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Beneficiary
Maximum Out Of Pocket
Individually identifiable health information
(EPO) Exclusive Provider Organization
16. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
Sub-acute Care
referral
Covered Expenses
17. 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
(Non-par) Non-Participating Provider
disclosure
ids
business associate
18. 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.
(COBRA)
IIHI
Allowed Expenses
Protected health information
19. 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.
Participating Provider
ee schedule
Privacy officer
pos
20. 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
preauthorization
(EPO) Exclusive Provider Organization
Participating Provider
confidentiality
21. Health Information Portability and Accountability Act
HIPAA
(ERISA) Employee Retirement Income Security Act of 1974
(DRG's)
ids
22. Someone who is eligible for or receiving benefits under an insurance policy or plan
(DCI) Duplicate Coverage Inquiry
Pre-existing Condition Exclusion
Beneficiary
claim
23. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Protected health information
Coordinated Coverage
(ERISA) Employee Retirement Income Security Act of 1974
disclosure
24. 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
(POS) Point-of Service Plan
ee schedule
(COBRA)
Referral
25. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
security officer
Medigap Insurance
Claim
clearinghouse
26. American Medical Association
referral
AMA
Medigap Insurance
(POS) Point-of Service Plan
27. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(ERISA) Employee Retirement Income Security Act of 1974
(PCN) Primary Care Network
referral
hmo
28. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
authorization form
Resonable Charge
(UR) Utilization review
confidentiality
29. What the insurance company will consider paying for as defined in the contract.
IIHI
Confidential communication
Covered Expenses
business associate
30. 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
security officer
(PCN) Primary Care Network
cash flow
Sub-acute Care
31. Is the provider who renders a service to a patient
Treating or performing physician
ordering physician
Coordinated Coverage
(COB) Coordination of Benefits
32. 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
health care provider
(POS) Point-of Service Plan
authorization form
Beneficiary
33. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Security Rule
fraud
referral
Participating Provider
34. A monthly fee paid by the insured for specific medical insurance coverage
fraud
(PEC) Pre-existing condition
premium
covered entity
35. 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
epo
deductible
Deductible
Notice of Privacy Practices
36. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(DME) Durable Medical Equipment
(DCI) Duplicate Coverage Inquiry
(ERISA) Employee Retirement Income Security Act of 1974
transaction
37. The condition of being secluded from the presence or view of others.
(PAC) Pre- Admission Certification
Covered Expenses
Preauthorization
privacy
38. 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
AMA
open panel HMO
Pre-existing Condition Exclusion
deductible
39. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
ee schedule
(DOS) Date of Service
consulting physician
HIPAA
40. 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
referring physician
Confidential communication
referral
Participating Provider
41. 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
Subscriber
Embezzlement
econdary Payer
Medigap Insurance
42. A rule - condition - or requirement
confidentiality
Standard
Open Enrollment
epo
43. An intentional misrepresentation of the facts to deceive or mislead another.
etiquette
Treating or performing physician
fraud
(TPA) Third Party Administrator
44. 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
consulting physician
(COBRA)
electronic media
45. 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
Pre-certification
breach of confidential communication
subscriber
authorization form
46. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
abuse
ids
econdary Payer
referral
47. Standards of conduct generally accepted as a moral guide for behavior.
ethics
Experimental Procedures
privacy
(PCN) Primary Care Network
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.
Individually identifiable health information
econdary Payer
state preemption
referral
49. 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.
referral
state preemption
(COBRA)
complience
50. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
ppo
self-referral
Subscriber
Privacy officer