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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 willful act by an employee of taking possession of an employer's money
Embezzlement
covered entity
self-referral
(PCP) Primary Care Physician
2. The period of time that payment for Medicare inpatient hospital benefits are available
transaction
Supplementary Medical Insurance
Referral
benefit period
3. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
security officer
ethics
pcp
(PPS) Hospital Impatient Prospective Payment System
4. Approval or consent by a primary physician for patient referral to ancillary services and specialists
epo
(PPS) Hospital Impatient Prospective Payment System
ppo
Referral
5. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
privacy
breach of confidential communication
(ABN) Advance Beneficiary Notice
6. Someone who is eligible for or receiving benefits under an insurance policy or plan
(APC) Ambulatory Patient Classifications
(PCN) Primary Care Network
Beneficiary
etiquette
7. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Privacy officer
disclosure
(PAC) Pre- Admission Certification
8. The maximum amount a plan pays for a covered service
Network
(ABN) Advance Beneficiary Notice
claim
Allowed Expenses
9. 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.
business associate
Open Enrollment
(UR) Utilization review
(DME) Durable Medical Equipment
10. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Medigap Insurance
confidentiality
Sub-acute Care
11. 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
attending physician
Security Rule
Individually identifiable health information
(DOS) Date of Service
12. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
hmo
Treating or performing physician
(UR) Utilization review
(PEC) Pre-existing condition
13. A structure for classifying outpatient services and procedures for purpose of payment
Claim
(APC) Ambulatory Patient Classifications
(ERISA) Employee Retirement Income Security Act of 1974
(UCR) Usual - Customary and Reasonable
14. 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.
(PCP) Primary Care Physician
security officer
Assignment & Authorization
clearinghouse
15. A review of the need for inpatient hospital care - completed before the actual admission
(UCR) Usual - Customary and Reasonable
(PAC) Pre- Admission Certification
premium
e-health information management
16. 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.
state preemption
self-referral
Security Rule
Sub-acute Care
17. Billing for services not performed
phantom billing
(ABN) Advance Beneficiary Notice
claim
Treating or performing physician
18. Customs - rules of conduct - courtesy - and manners of the medical profession
Privileged information
Supplementary Medical Insurance
Beneficiary
etiquette
19. 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
transaction
(UR) Utilization review
nonprivileged information
e-health information management
20. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
health care provider
electronic media
health care provider
21. Medicare's method of paying acute care hospitals for inpatient care
Pre-existing Condition Exclusion
(PPS) Hospital Impatient Prospective Payment System
consulting physician
covered entity
22. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
authorization form
deductible
Medigap Insurance
Protected health information
23. Is the provider who renders a service to a patient
attending physician
crossover claim
Treating or performing physician
(DRG's)
24. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
subscriber
Open Enrollment
breach of confidential communication
25. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Privacy officer
(DCI) Duplicate Coverage Inquiry
Specialist
(COBRA)
26. 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
econdary Payer
Pre-existing Condition Exclusion
(DOS) Date of Service
(ABN) Advance Beneficiary Notice
27. Is the provider who renders a service to a patient
subscriber
state preemption
business associate
Treating or performing physician
28. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(APC) Ambulatory Patient Classifications
Standard
ordering physician
Claim
29. 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.
Assignment & Authorization
Maximum Out Of Pocket
covered entity
state preemption
30. Medicare's method of paying acute care hospitals for inpatient care
(AOB) Assignment of Benefits
ee schedule
(EPO) Exclusive Provider Organization
(PPS) Hospital Impatient Prospective Payment System
31. 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
Security Rule
deductible
(DME) Durable Medical Equipment
(ERISA) Employee Retirement Income Security Act of 1974
32. An intentional misrepresentation of the facts to deceive or mislead another.
(COB) Coordination of Benefits
fraud
ethics
Confidential communication
33. A list of the amount to be paid by an insurance company for each procedure service
Treating or performing physician
Network
(POS) Point-of Service Plan
ee schedule
34. 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
authorization form
crossover claim
econdary Payer
phantom billing
35. 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
(UR) Utilization review
(POS) Point-of Service Plan
cash flow
36. 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
Treating or performing physician
Sub-acute Care
Maximum Out Of Pocket
pos
37. 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.
(PEC) Pre-existing condition
premium
pcp
Protected health information
38. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Supplementary Medical Insurance
Amblatory Care
Specialist
39. Health Information Portability and Accountability Act
Privileged information
HIPAA
security officer
Protected health information
40. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
pos
Individually identifiable health information
complience
complience plan
41. Integrating benefits payable under more than one health insurance.
Privacy officer
Embezzlement
state preemption
Coordinated Coverage
42. 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
claim
disclosure
fraud
43. 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
ppo
Maximum Out Of Pocket
Specialist
44. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(APC) Ambulatory Patient Classifications
consent
Privileged information
hmo
45. A patient claim is eligible for medicare and medicaid
crossover claim
transaction
Experimental Procedures
(PPS) Hospital Impatient Prospective Payment System
46. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Covered Expenses
Experimental Procedures
HIPAA
(UR) Utilization review
47. What the insurance company will consider paying for as defined in the contract.
referral
Covered Expenses
(PCN) Primary Care Network
Supplementary Medical Insurance
48. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
(PEC) Pre-existing condition
state preemption
open panel HMO
49. 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
Pre-existing Condition Exclusion
IIHI
Protected health information
Standard
50. A nonprofit integrated delivery system
(PCP) Primary Care Physician
Allowed Expenses
medical foundation
(DCI) Duplicate Coverage Inquiry