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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. 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
Medigap Insurance
security officer
Beneficiary
(DME) Durable Medical Equipment
2. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Pre-existing Condition Exclusion
consulting physician
Specialist
(APC) Ambulatory Patient Classifications
3. Individually identifiable health information
Covered Expenses
disclosure
Amblatory Care
IIHI
4. 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
Subscriber
Assignment & Authorization
(EPO) Exclusive Provider Organization
self-referral
5. Someone who is eligible for or receiving benefits under an insurance policy or plan
Protected health information
(UR) Utilization review
Beneficiary
phantom billing
6. Unauthorized release of information
(UR) Utilization review
breach of confidential communication
Beneficiary
Specialist
7. A provision that apples when a person is covered under more than one group medical program
(PAC) Pre- Admission Certification
pos
(COB) Coordination of Benefits
Participating Provider
8. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(APC) Ambulatory Patient Classifications
confidentiality
(OOPs) Out of Pocket Costs/Expenses
health care provider
9. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
econdary Payer
privacy
(TPA) Third Party Administrator
(PCN) Primary Care Network
10. 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.
Coordinated Coverage
phantom billing
Confidential communication
Notice of Privacy Practices
11. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
Specialist
(DRG's)
Experimental Procedures
Assignment & Authorization
12. 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.
health care provider
self-referral
Pre-certification
disclosure
13. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
cash flow
attending physician
covered entity
14. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
e-health information management
Subscriber
complience
Covered Expenses
15. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Network
security officer
subscriber
16. 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
hmo
breach of confidential communication
(DOS) Date of Service
Preauthorization
17. 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
clearinghouse
attending physician
claim
covered entity
18. A clinic that is owned by the HMO and the physicians are employees of the HMO
(POS) Point-of Service Plan
closed panel HMO
prepaid plan
authorization form
19. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
e-health information management
(DCI) Duplicate Coverage Inquiry
econdary Payer
consent
20. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(POS) Point-of Service Plan
Resonable Charge
(UR) Utilization review
open panel HMO
21. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
medical foundation
Amblatory Care
(PAC) Pre- Admission Certification
Individually identifiable health information
22. 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
electronic media
fraud
Sub-acute Care
transaction
23. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Claim
Individually identifiable health information
covered entity
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.
Referral
Deductible
Privileged information
Allowed Expenses
25. 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
nonprivileged information
Covered Expenses
(ABN) Advance Beneficiary Notice
fraud
26. 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
IIHI
authorization form
Treating or performing physician
benefit period
27. 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
electronic media
phantom billing
HIPAA
Security Rule
28. Health Information Portability and Accountability Act
HIPAA
(DRG's)
confidentiality
(UCR) Usual - Customary and Reasonable
29. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
transaction
(ERISA) Employee Retirement Income Security Act of 1974
benefit period
(EPO) Exclusive Provider Organization
30. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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31. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Maximum Out Of Pocket
Confidential communication
nonprivileged information
32. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
ethics
(DOS) Date of Service
hmo
(UR) Utilization review
33. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Medigap Insurance
(UR) Utilization review
claim
medical foundation
34. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Privileged information
subscriber
fraud
(ERISA) Employee Retirement Income Security Act of 1974
35. 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
(PCN) Primary Care Network
epo
ee schedule
36. 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
(PAC) Pre- Admission Certification
Out of Network (OON)
(POS) Point-of Service Plan
(PCP) Primary Care Physician
37. A review of the need for inpatient hospital care - completed before the actual admission
disclosure
(PAC) Pre- Admission Certification
Pre-certification
Covered Expenses
38. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
ppo
phantom billing
Experimental Procedures
39. 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.
(DCI) Duplicate Coverage Inquiry
Embezzlement
(EPO) Exclusive Provider Organization
security officer
40. Medical staff member who is legally responsible for the care and treatment given to a patient.
Assignment & Authorization
attending physician
e-health information management
Embezzlement
41. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
nonprivileged information
Individually identifiable health information
clearinghouse
42. 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.
Privileged information
Individually identifiable health information
Protected health information
phantom billing
43. 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)
Protected health information
clearinghouse
(ABN) Advance Beneficiary Notice
Consent form
44. The condition of being secluded from the presence or view of others.
AMA
privacy
ethics
(DRG's)
45. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Privacy officer
Medigap Insurance
electronic media
disclosure
46. 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
Out of Network (OON)
subscriber
hmo
(COBRA)
47. The dates of healthcare services were provided to the beneficiary
benefit period
(DOS) Date of Service
(PCP) Primary Care Physician
Confidential communication
48. Is the provider who renders a service to a patient
(EPO) Exclusive Provider Organization
Treating or performing physician
preauthorization
Privileged information
49. The period of time that payment for Medicare inpatient hospital benefits are available
(APC) Ambulatory Patient Classifications
Maximum Out Of Pocket
benefit period
closed panel HMO
50. 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
Allowed Expenses
(POS) Point-of Service Plan
Subscriber