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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
e-health information management
Covered Expenses
(AOB) Assignment of Benefits
2. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(PCN) Primary Care Network
Confidential communication
consulting physician
benefit period
3. 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
Deductible
crossover claim
ordering physician
transaction
4. The condition of being secluded from the presence or view of others.
Resonable Charge
deductible
Embezzlement
privacy
5. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
AMA
pcp
epo
(AOB) Assignment of Benefits
6. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
health care provider
(OOPs) Out of Pocket Costs/Expenses
(DRG's)
breach of confidential communication
7. 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
(COB) Coordination of Benefits
Participating Provider
Deductible
(COBRA)
8. 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.
AMA
hmo
(COBRA)
security officer
9. A health insurance enrollee chooses to see an out of network provider without authorization
(TPA) Third Party Administrator
(COBRA)
closed panel HMO
self-referral
10. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
crossover claim
IIHI
Participating Provider
11. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
complience plan
(DME) Durable Medical Equipment
disclosure
referral
12. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
pcp
(ABN) Advance Beneficiary Notice
Claim
benefit period
13. Health Information Portability and Accountability Act
Consent form
AMA
HIPAA
(EPO) Exclusive Provider Organization
14. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
privacy
confidentiality
crossover claim
clearinghouse
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
(COBRA)
(UR) Utilization review
Security Rule
(POS) Point-of Service Plan
16. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(ABN) Advance Beneficiary Notice
Pre-existing Condition Exclusion
deductible
covered entity
17. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Sub-acute Care
Specialist
Open Enrollment
(ERISA) Employee Retirement Income Security Act of 1974
18. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
IIHI
Sub-acute Care
referring physician
19. Billing for services not performed
confidentiality
phantom billing
(DOS) Date of Service
medical foundation
20. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
business associate
(COB) Coordination of Benefits
Referral
(PEC) Pre-existing condition
21. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(POS) Point-of Service Plan
Referral
ids
Security Rule
22. 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
AMA
open panel HMO
complience plan
(PCP) Primary Care Physician
23. A structure for classifying outpatient services and procedures for purpose of payment
econdary Payer
premium
(APC) Ambulatory Patient Classifications
Assignment & Authorization
24. 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.
(POS) Point-of Service Plan
Preauthorization
Medigap Insurance
Privileged information
25. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
HIPAA
Maximum Out Of Pocket
(ABN) Advance Beneficiary Notice
26. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Medigap Insurance
crossover claim
deductible
complience plan
27. 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.
Subscriber
self-referral
Protected health information
closed panel HMO
28. A patient claim is eligible for medicare and medicaid
Preauthorization
Covered Expenses
crossover claim
Treating or performing physician
29. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
covered entity
Experimental Procedures
closed panel HMO
30. The maximum amount a plan pays for a covered service
ppo
Treating or performing physician
Allowed Expenses
etiquette
31. 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
Deductible
disclosure
ppo
complience plan
32. 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
HIPAA
authorization form
Assignment & Authorization
Deductible
33. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(ABN) Advance Beneficiary Notice
(UCR) Usual - Customary and Reasonable
HIPAA
Network
34. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
Experimental Procedures
transaction
Individually identifiable health information
35. 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
health care provider
(TPA) Third Party Administrator
(ABN) Advance Beneficiary Notice
(COBRA)
36. The condition of being secluded from the presence or view of others.
Beneficiary
Pre-existing Condition Exclusion
(UCR) Usual - Customary and Reasonable
privacy
37. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
ethics
(Non-par) Non-Participating Provider
Out of Network (OON)
(ERISA) Employee Retirement Income Security Act of 1974
38. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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39. Individually identifiable health information
confidentiality
clearinghouse
IIHI
(AOB) Assignment of Benefits
40. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
Experimental Procedures
Confidential communication
epo
41. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
abuse
Out of Network (OON)
Coordinated Coverage
confidentiality
42. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Referral
Individually identifiable health information
(POS) Point-of Service Plan
43. A review of the need for inpatient hospital care - completed before the actual admission
Protected health information
(PAC) Pre- Admission Certification
ppo
complience
44. Is the provider who renders a service to a patient
Supplementary Medical Insurance
Subscriber
ppo
Treating or performing physician
45. A nonprofit integrated delivery system
Coordinated Coverage
Notice of Privacy Practices
attending physician
medical foundation
46. 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
(PEC) Pre-existing condition
econdary Payer
breach of confidential communication
Assignment & Authorization
47. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Embezzlement
(UR) Utilization review
complience plan
Beneficiary
48. 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
Maximum Out Of Pocket
(PCN) Primary Care Network
(PAC) Pre- Admission Certification
Protected health information
49. Customs - rules of conduct - courtesy - and manners of the medical profession
authorization form
prepaid plan
etiquette
privacy
50. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
fraud
disclosure
Sub-acute Care