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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. 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
Pre-certification
(PCN) Primary Care Network
consent
(ERISA) Employee Retirement Income Security Act of 1974
2. 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.
(TPA) Third Party Administrator
deductible
Resonable Charge
state preemption
3. 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
fraud
(PCN) Primary Care Network
privacy
Security Rule
4. 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.
Deductible
(DCI) Duplicate Coverage Inquiry
Protected health information
Network
5. 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.
ethics
Out of Network (OON)
benefit period
business associate
6. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Participating Provider
(ABN) Advance Beneficiary Notice
Standard
Resonable Charge
7. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(DRG's)
Specialist
(DRG's)
consulting physician
8. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
e-health information management
Beneficiary
(OOPs) Out of Pocket Costs/Expenses
9. 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
Supplementary Medical Insurance
Allowed Expenses
econdary Payer
privacy
10. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
medical foundation
Consent form
subscriber
Assignment & Authorization
11. Medicare's method of paying acute care hospitals for inpatient care
IIHI
Security Rule
(PAC) Pre- Admission Certification
(PPS) Hospital Impatient Prospective Payment System
12. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Beneficiary
confidentiality
hmo
epo
13. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
prepaid plan
Protected health information
etiquette
14. 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
(OOPs) Out of Pocket Costs/Expenses
abuse
epo
Allowed Expenses
15. 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
(ERISA) Employee Retirement Income Security Act of 1974
(POS) Point-of Service Plan
electronic media
Sub-acute Care
16. 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
security officer
hmo
(ABN) Advance Beneficiary Notice
covered entity
17. Individually identifiable health information
(OOPs) Out of Pocket Costs/Expenses
Subscriber
(UCR) Usual - Customary and Reasonable
IIHI
18. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Covered Expenses
Claim
(ERISA) Employee Retirement Income Security Act of 1974
clearinghouse
19. The period of time that payment for Medicare inpatient hospital benefits are available
security officer
Embezzlement
Beneficiary
benefit period
20. 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
Preauthorization
(ERISA) Employee Retirement Income Security Act of 1974
pcp
prepaid plan
21. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
HIPAA
business associate
Privileged information
22. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
breach of confidential communication
pos
attending physician
23. 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
Participating Provider
(TPA) Third Party Administrator
self-referral
subscriber
24. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(ERISA) Employee Retirement Income Security Act of 1974
state preemption
(COB) Coordination of Benefits
e-health information management
25. 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
Allowed Expenses
attending physician
ee schedule
(COBRA)
26. 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
self-referral
benefit period
Referral
27. A monthly fee paid by the insured for specific medical insurance coverage
(POS) Point-of Service Plan
premium
(COB) Coordination of Benefits
Protected health information
28. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
state preemption
ordering physician
Pre-existing Condition Exclusion
breach of confidential communication
29. A patient claim is eligible for medicare and medicaid
(Non-par) Non-Participating Provider
crossover claim
Participating Provider
open panel HMO
30. Is the provider who renders a service to a patient
Resonable Charge
Confidential communication
Treating or performing physician
(Non-par) Non-Participating Provider
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.
Consent form
epo
Consent form
business associate
32. A privileged communication that may be disclosed only with the patient's permission.
consulting physician
Confidential communication
authorization form
Claim
33. 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)
prepaid plan
(UR) Utilization review
Consent form
abuse
34. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
covered entity
(UR) Utilization review
closed panel HMO
security officer
35. 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
covered entity
consulting physician
Out of Network (OON)
phantom billing
36. 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
(AOB) Assignment of Benefits
consent
Participating Provider
Consent form
37. 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
referring physician
Pre-existing Condition Exclusion
prepaid plan
(DCI) Duplicate Coverage Inquiry
38. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Beneficiary
Sub-acute Care
transaction
preauthorization
39. Health Information Portability and Accountability Act
(DRG's)
referral
HIPAA
epo
40. Verbal or written agreement that gives approval to some action - situation - or statement.
ethics
Confidential communication
epo
consent
41. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Maximum Out Of Pocket
(DOS) Date of Service
medical foundation
Claim
42. American Medical Association
ids
Notice of Privacy Practices
privacy
AMA
43. 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
Maximum Out Of Pocket
subscriber
Assignment & Authorization
confidentiality
44. A patient claim is eligible for medicare and medicaid
etiquette
crossover claim
health care provider
self-referral
45. Is the provider who renders a service to a patient
Network
referral
Pre-certification
Treating or performing physician
46. 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
benefit period
pos
Treating or performing physician
47. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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48. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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49. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
business associate
Experimental Procedures
(COBRA)
50. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
business associate
disclosure
HIPAA
(APC) Ambulatory Patient Classifications