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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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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. A health insurance enrollee chooses to see an out of network provider without authorization
(PPS) Hospital Impatient Prospective Payment System
abuse
self-referral
covered entity
2. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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3. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
(DCI) Duplicate Coverage Inquiry
Assignment & Authorization
business associate
4. 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
epo
e-health information management
referring physician
5. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
(PPS) Hospital Impatient Prospective Payment System
Sub-acute Care
IIHI
6. A monthly fee paid by the insured for specific medical insurance coverage
(COBRA)
consent
self-referral
premium
7. The amount of actual money available to the medical practice
Pre-existing Condition Exclusion
ordering physician
open panel HMO
cash flow
8. 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
ppo
consulting physician
epo
prepaid plan
9. 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.
attending physician
AMA
Protected health information
ids
10. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
HIPAA
attending physician
Network
11. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Privacy officer
(PCN) Primary Care Network
(PEC) Pre-existing condition
(AOB) Assignment of Benefits
12. Someone who is eligible for or receiving benefits under an insurance policy or plan
(COBRA)
clearinghouse
AMA
Beneficiary
13. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Supplementary Medical Insurance
(OOPs) Out of Pocket Costs/Expenses
e-health information management
clearinghouse
14. 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
Security Rule
e-health information management
econdary Payer
15. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Coordinated Coverage
pos
Resonable Charge
(TPA) Third Party Administrator
16. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.
(APC) Ambulatory Patient Classifications
Notice of Privacy Practices
privacy
(POS) Point-of Service Plan
17. Is the provider who renders a service to a patient
HIPAA
Coordinated Coverage
Treating or performing physician
Embezzlement
18. 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
Standard
Out of Network (OON)
authorization form
Allowed Expenses
19. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)
Allowed Expenses
Consent form
econdary Payer
nonprivileged information
20. Medical staff member who is legally responsible for the care and treatment given to a patient.
Specialist
Pre-existing Condition Exclusion
attending physician
(DOS) Date of Service
21. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
claim
(DOS) Date of Service
Referral
electronic media
22. A health insurance enrollee chooses to see an out of network provider without authorization
ethics
consent
premium
self-referral
23. 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
(DME) Durable Medical Equipment
transaction
Specialist
subscriber
24. 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
nonprivileged information
Preauthorization
Experimental Procedures
25. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Out of Network (OON)
clearinghouse
e-health information management
electronic media
26. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
breach of confidential communication
Supplementary Medical Insurance
(APC) Ambulatory Patient Classifications
27. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Deductible
(Non-par) Non-Participating Provider
complience plan
Referral
28. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Claim
abuse
electronic media
(AOB) Assignment of Benefits
29. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)
(ABN) Advance Beneficiary Notice
referring physician
Consent form
Pre-existing Condition Exclusion
30. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(PPS) Hospital Impatient Prospective Payment System
subscriber
(APC) Ambulatory Patient Classifications
fraud
31. 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.
(DME) Durable Medical Equipment
Open Enrollment
hmo
Privileged information
32. Integrating benefits payable under more than one health insurance.
Claim
(POS) Point-of Service Plan
Coordinated Coverage
business associate
33. 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
business associate
open panel HMO
attending physician
Preauthorization
34. 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
Standard
Coordinated Coverage
(COBRA)
open panel HMO
35. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
privacy
preauthorization
(PCN) Primary Care Network
(PEC) Pre-existing condition
36. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
security officer
deductible
Notice of Privacy Practices
open panel HMO
37. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
preauthorization
Sub-acute Care
medical foundation
38. Unauthorized release of information
breach of confidential communication
(PAC) Pre- Admission Certification
security officer
Covered Expenses
39. Individually identifiable health information
attending physician
IIHI
Protected health information
pos
40. 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
business associate
Pre-existing Condition Exclusion
Experimental Procedures
open panel HMO
41. American Medical Association
authorization form
Allowed Expenses
AMA
transaction
42. 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
Sub-acute Care
Deductible
attending physician
cash flow
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.
Open Enrollment
covered entity
breach of confidential communication
health care provider
44. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Out of Network (OON)
complience plan
Network
ids
45. 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
(APC) Ambulatory Patient Classifications
Privileged information
(DCI) Duplicate Coverage Inquiry
epo
46. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
Notice of Privacy Practices
Maximum Out Of Pocket
prepaid plan
Medigap Insurance
47. A willful act by an employee of taking possession of an employer's money
Embezzlement
(POS) Point-of Service Plan
ids
electronic media
48. 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
consulting physician
Preauthorization
Maximum Out Of Pocket
Supplementary Medical Insurance
49. The transmission of information between two parties to carry out financial or administrative activities related to health care.
ethics
econdary Payer
crossover claim
transaction
50. 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
Amblatory Care
Supplementary Medical Insurance
covered entity
Deductible
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