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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. 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
complience
Allowed Expenses
Security Rule
(PCP) Primary Care Physician
2. 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
Network
IIHI
(Non-par) Non-Participating Provider
(POS) Point-of Service Plan
3. Health Information Portability and Accountability Act
security officer
pos
HIPAA
(PCP) Primary Care Physician
4. 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
complience plan
Claim
(TPA) Third Party Administrator
(AOB) Assignment of Benefits
5. An organization of provider sites with a contracted relationship that offer services
privacy
ids
epo
Privacy officer
6. 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
Assignment & Authorization
AMA
econdary Payer
breach of confidential communication
7. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
attending physician
Referral
cash flow
8. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Out of Network (OON)
premium
disclosure
Specialist
9. Integrating benefits payable under more than one health insurance.
(DRG's)
Coordinated Coverage
hmo
ids
10. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Claim
ordering physician
ee schedule
business associate
11. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Experimental Procedures
Assignment & Authorization
(EPO) Exclusive Provider Organization
Allowed Expenses
12. Health Information Portability and Accountability Act
Allowed Expenses
(DCI) Duplicate Coverage Inquiry
HIPAA
(AOB) Assignment of Benefits
13. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
epo
(OOPs) Out of Pocket Costs/Expenses
nonprivileged information
Open Enrollment
14. 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
(PCP) Primary Care Physician
cash flow
(DME) Durable Medical Equipment
15. 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
Protected health information
ids
preauthorization
16. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
clearinghouse
(EPO) Exclusive Provider Organization
preauthorization
(PEC) Pre-existing condition
17. A rule - condition - or requirement
Standard
(PCN) Primary Care Network
Medigap Insurance
Sub-acute Care
18. 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
ethics
(UR) Utilization review
Security Rule
(PPS) Hospital Impatient Prospective Payment System
19. 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
Treating or performing physician
Pre-existing Condition Exclusion
crossover claim
IIHI
20. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
epo
Privacy officer
(APC) Ambulatory Patient Classifications
21. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
Pre-certification
consulting physician
Open Enrollment
Resonable Charge
22. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Consent form
transaction
deductible
disclosure
23. A nonprofit integrated delivery system
(PEC) Pre-existing condition
hmo
closed panel HMO
medical foundation
24. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
econdary Payer
claim
etiquette
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
ids
closed panel HMO
clearinghouse
26. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(ABN) Advance Beneficiary Notice
benefit period
epo
Medigap Insurance
27. An intentional misrepresentation of the facts to deceive or mislead another.
referring physician
fraud
(PAC) Pre- Admission Certification
ppo
28. 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.
security officer
Covered Expenses
(PAC) Pre- Admission Certification
fraud
29. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
(COBRA)
premium
cash flow
30. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
premium
electronic media
Sub-acute Care
claim
31. 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
Experimental Procedures
Treating or performing physician
Pre-existing Condition Exclusion
(PCN) Primary Care Network
32. Unauthorized release of information
(ABN) Advance Beneficiary Notice
Out of Network (OON)
deductible
breach of confidential communication
33. 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
AMA
cash flow
Sub-acute Care
Supplementary Medical Insurance
34. 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.
(UR) Utilization review
fraud
state preemption
(DME) Durable Medical Equipment
35. 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.
etiquette
(PAC) Pre- Admission Certification
(Non-par) Non-Participating Provider
business associate
36. A willful act by an employee of taking possession of an employer's money
epo
(COBRA)
Embezzlement
Sub-acute Care
37. A rule - condition - or requirement
complience plan
subscriber
Standard
Open Enrollment
38. 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
referring physician
(ERISA) Employee Retirement Income Security Act of 1974
Allowed Expenses
epo
39. Is a provider who sends the patients for testing or treatment
IIHI
referring physician
privacy
(PPS) Hospital Impatient Prospective Payment System
40. Billing for services not performed
phantom billing
Treating or performing physician
clearinghouse
authorization form
41. The condition of being secluded from the presence or view of others.
closed panel HMO
deductible
(POS) Point-of Service Plan
privacy
42. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Subscriber
pcp
Deductible
fraud
43. A willful act by an employee of taking possession of an employer's money
referring physician
Embezzlement
nonprivileged information
(ERISA) Employee Retirement Income Security Act of 1974
44. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Supplementary Medical Insurance
Medigap Insurance
complience plan
premium
45. Medical staff member who is legally responsible for the care and treatment given to a patient.
hmo
Consent form
(DME) Durable Medical Equipment
attending physician
46. 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
(ERISA) Employee Retirement Income Security Act of 1974
Sub-acute Care
open panel HMO
(OOPs) Out of Pocket Costs/Expenses
47. 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
(EPO) Exclusive Provider Organization
(PEC) Pre-existing condition
Maximum Out Of Pocket
48. 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
Participating Provider
pcp
econdary Payer
ee schedule
49. 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.
Assignment & Authorization
cash flow
crossover claim
Privileged information
50. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
HIPAA
Covered Expenses
Standard
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