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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. 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
etiquette
etiquette
closed panel HMO
2. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
authorization form
(ERISA) Employee Retirement Income Security Act of 1974
pcp
3. 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.
(AOB) Assignment of Benefits
Privacy officer
Network
closed panel HMO
4. A nonprofit integrated delivery system
Supplementary Medical Insurance
phantom billing
ordering physician
medical foundation
5. Health Information Portability and Accountability Act
HIPAA
self-referral
breach of confidential communication
deductible
6. 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.
(PAC) Pre- Admission Certification
business associate
medical foundation
AMA
7. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
covered entity
(TPA) Third Party Administrator
health care provider
phantom billing
8. 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
Participating Provider
Coordinated Coverage
Consent form
Assignment & Authorization
9. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(PAC) Pre- Admission Certification
referral
(PPS) Hospital Impatient Prospective Payment System
clearinghouse
10. 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
authorization form
Experimental Procedures
health care provider
consent
11. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
consent
(PCP) Primary Care Physician
disclosure
12. A clinic that is owned by the HMO and the physicians are employees of the HMO
complience
(ERISA) Employee Retirement Income Security Act of 1974
closed panel HMO
consulting physician
13. 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
(POS) Point-of Service Plan
(AOB) Assignment of Benefits
nonprivileged information
prepaid plan
14. Health Information Portability and Accountability Act
HIPAA
nonprivileged information
(COB) Coordination of Benefits
(UCR) Usual - Customary and Reasonable
15. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
Consent form
(Non-par) Non-Participating Provider
HIPAA
16. 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
(ABN) Advance Beneficiary Notice
(PAC) Pre- Admission Certification
Allowed Expenses
IIHI
17. 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
ordering physician
ppo
(Non-par) Non-Participating Provider
covered entity
18. 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
Medigap Insurance
Coordinated Coverage
open panel HMO
19. 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
open panel HMO
Security Rule
Specialist
Individually identifiable health information
20. 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
(EPO) Exclusive Provider Organization
HIPAA
pcp
Participating Provider
21. Standards of conduct generally accepted as a moral guide for behavior.
ethics
Pre-existing Condition Exclusion
(UR) Utilization review
Protected health information
22. 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)
Resonable Charge
Consent form
Confidential communication
Amblatory Care
23. Is a provider who sends the patients for testing or treatment
(EPO) Exclusive Provider Organization
medical foundation
referring physician
(POS) Point-of Service Plan
24. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
Embezzlement
nonprivileged information
authorization form
subscriber
25. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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26. Is the provider who renders a service to a patient
subscriber
prepaid plan
Preauthorization
Treating or performing physician
27. 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
IIHI
self-referral
breach of confidential communication
(POS) Point-of Service Plan
28. 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
(EPO) Exclusive Provider Organization
health care provider
crossover claim
Participating Provider
29. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Deductible
Claim
hmo
attending physician
30. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
(DCI) Duplicate Coverage Inquiry
confidentiality
security officer
31. A provision that apples when a person is covered under more than one group medical program
Privileged information
ids
(COB) Coordination of Benefits
closed panel HMO
32. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
AMA
confidentiality
Specialist
Network
33. Billing for services not performed
Resonable Charge
phantom billing
Protected health information
Confidential communication
34. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
epo
Participating Provider
Claim
35. 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
(COBRA)
(DOS) Date of Service
(DME) Durable Medical Equipment
nonprivileged information
36. 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
closed panel HMO
Maximum Out Of Pocket
privacy
Pre-existing Condition Exclusion
37. 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
crossover claim
Pre-certification
38. 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
crossover claim
Experimental Procedures
abuse
econdary Payer
39. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
disclosure
Resonable Charge
Pre-certification
40. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
pos
breach of confidential communication
(TPA) Third Party Administrator
Treating or performing physician
41. 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
pcp
(AOB) Assignment of Benefits
benefit period
(DCI) Duplicate Coverage Inquiry
42. 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
(ERISA) Employee Retirement Income Security Act of 1974
(UR) Utilization review
Allowed Expenses
IIHI
43. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
e-health information management
epo
closed panel HMO
44. 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)
claim
Security Rule
Consent form
ppo
45. 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
Supplementary Medical Insurance
Notice of Privacy Practices
etiquette
(PCN) Primary Care Network
46. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
crossover claim
ppo
(PEC) Pre-existing condition
Participating Provider
47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Security Rule
pcp
(OOPs) Out of Pocket Costs/Expenses
complience plan
48. 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
authorization form
business associate
(POS) Point-of Service Plan
(COBRA)
49. A list of the amount to be paid by an insurance company for each procedure service
econdary Payer
Resonable Charge
Sub-acute Care
ee schedule
50. 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.
attending physician
health care provider
Privileged information
Specialist