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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.
If you are not ready to take this test, you can
study here
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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. 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
Experimental Procedures
Deductible
consulting physician
2. 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
(APC) Ambulatory Patient Classifications
complience
privacy
Supplementary Medical Insurance
3. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Subscriber
Medigap Insurance
electronic media
transaction
4. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
confidentiality
(PCN) Primary Care Network
hmo
prepaid plan
5. 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
authorization form
(ABN) Advance Beneficiary Notice
(PPS) Hospital Impatient Prospective Payment System
(PAC) Pre- Admission Certification
6. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Amblatory Care
ids
Pre-existing Condition Exclusion
7. The transmission of information between two parties to carry out financial or administrative activities related to health care.
state preemption
Open Enrollment
transaction
hmo
8. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Individually identifiable health information
Amblatory Care
ppo
9. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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10. 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)
Consent form
(UR) Utilization review
(ERISA) Employee Retirement Income Security Act of 1974
phantom billing
11. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
Deductible
privacy
Beneficiary
12. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
prepaid plan
deductible
(UR) Utilization review
13. 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
Sub-acute Care
self-referral
(PAC) Pre- Admission Certification
14. The amount of actual money available to the medical practice
cash flow
Security Rule
(TPA) Third Party Administrator
(PEC) Pre-existing condition
15. 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
(DOS) Date of Service
Standard
(AOB) Assignment of Benefits
Individually identifiable health information
16. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
attending physician
complience
(ERISA) Employee Retirement Income Security Act of 1974
abuse
17. A monthly fee paid by the insured for specific medical insurance coverage
Participating Provider
electronic media
premium
(AOB) Assignment of Benefits
18. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
attending physician
(EPO) Exclusive Provider Organization
ids
Medigap Insurance
19. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
breach of confidential communication
cash flow
open panel HMO
pcp
20. 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
ethics
ethics
Sub-acute Care
Open Enrollment
21. Is a provider who sends the patients for testing or treatment
referring physician
ethics
benefit period
Notice of Privacy Practices
22. The dates of healthcare services were provided to the beneficiary
claim
fraud
complience
(DOS) Date of Service
23. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Security Rule
Sub-acute Care
Embezzlement
Individually identifiable health information
24. A provision that apples when a person is covered under more than one group medical program
Allowed Expenses
(COB) Coordination of Benefits
epo
(ERISA) Employee Retirement Income Security Act of 1974
25. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
e-health information management
(UR) Utilization review
abuse
(COBRA)
26. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Individually identifiable health information
Sub-acute Care
confidentiality
Deductible
27. 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
IIHI
Pre-existing Condition Exclusion
Standard
HIPAA
28. 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
AMA
Experimental Procedures
(APC) Ambulatory Patient Classifications
ethics
29. 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
referral
Maximum Out Of Pocket
Out of Network (OON)
Allowed Expenses
30. Health Information Portability and Accountability Act
Out of Network (OON)
HIPAA
breach of confidential communication
Supplementary Medical Insurance
31. The maximum amount a plan pays for a covered service
Allowed Expenses
breach of confidential communication
ppo
Network
32. 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
(Non-par) Non-Participating Provider
breach of confidential communication
phantom billing
33. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
electronic media
attending physician
Maximum Out Of Pocket
Participating Provider
34. 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
Privileged information
Preauthorization
subscriber
covered entity
35. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Privacy officer
complience plan
confidentiality
36. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
ppo
Consent form
Referral
Subscriber
37. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Pre-certification
Resonable Charge
(EPO) Exclusive Provider Organization
(TPA) Third Party Administrator
38. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
HIPAA
Resonable Charge
deductible
(PEC) Pre-existing condition
39. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Allowed Expenses
crossover claim
Claim
referral
40. 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.
Medigap Insurance
security officer
hmo
Participating Provider
41. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
complience plan
Beneficiary
business associate
42. 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
Pre-existing Condition Exclusion
hmo
AMA
43. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Consent form
(APC) Ambulatory Patient Classifications
(COB) Coordination of Benefits
44. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
crossover claim
benefit period
(APC) Ambulatory Patient Classifications
ordering physician
45. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Resonable Charge
complience plan
referring physician
Referral
46. A clinic that is owned by the HMO and the physicians are employees of the HMO
complience plan
Resonable Charge
referring physician
closed panel HMO
47. 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
Supplementary Medical Insurance
epo
(DCI) Duplicate Coverage Inquiry
(COBRA)
48. Unauthorized release of information
HIPAA
complience
(COB) Coordination of Benefits
breach of confidential communication
49. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
open panel HMO
(APC) Ambulatory Patient Classifications
Privacy officer
e-health information management
50. 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.
Supplementary Medical Insurance
Notice of Privacy Practices
Experimental Procedures
Open Enrollment