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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. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
pcp
Privileged information
Confidential communication
2. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
business associate
cash flow
ordering physician
Consent form
3. Medical services provided on an outpatient basis
Deductible
Confidential communication
transaction
Amblatory Care
4. 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
deductible
(PEC) Pre-existing condition
(DRG's)
Preauthorization
5. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
abuse
covered entity
Individually identifiable health information
disclosure
6. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
referring physician
self-referral
consulting physician
7. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Individually identifiable health information
abuse
(PEC) Pre-existing condition
ids
8. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Deductible
medical foundation
Coordinated Coverage
Subscriber
9. The amount of actual money available to the medical practice
Assignment & Authorization
Security Rule
(PAC) Pre- Admission Certification
cash flow
10. 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
Pre-certification
(DRG's)
Out of Network (OON)
Deductible
11. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
breach of confidential communication
(UCR) Usual - Customary and Reasonable
disclosure
Referral
12. A monthly fee paid by the insured for specific medical insurance coverage
Medigap Insurance
premium
HIPAA
abuse
13. 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
consent
breach of confidential communication
Protected health information
14. 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.
self-referral
Embezzlement
Protected health information
benefit period
15. 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
(UCR) Usual - Customary and Reasonable
econdary Payer
nonprivileged information
covered entity
16. Medicare's method of paying acute care hospitals for inpatient care
Preauthorization
medical foundation
(PPS) Hospital Impatient Prospective Payment System
Amblatory Care
17. Unauthorized release of information
breach of confidential communication
Notice of Privacy Practices
Subscriber
Experimental Procedures
18. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Beneficiary
Medigap Insurance
Deductible
benefit period
19. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(PEC) Pre-existing condition
pos
Out of Network (OON)
20. American Medical Association
(DME) Durable Medical Equipment
AMA
(DRG's)
HIPAA
21. Is a provider who sends the patients for testing or treatment
referring physician
pcp
Experimental Procedures
(POS) Point-of Service Plan
22. 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
ethics
epo
Experimental Procedures
prepaid plan
23. What the insurance company will consider paying for as defined in the contract.
epo
attending physician
Covered Expenses
consulting physician
24. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(OOPs) Out of Pocket Costs/Expenses
ppo
(EPO) Exclusive Provider Organization
health care provider
25. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(DCI) Duplicate Coverage Inquiry
pcp
Notice of Privacy Practices
Privileged information
26. A privileged communication that may be disclosed only with the patient's permission.
medical foundation
premium
health care provider
Confidential communication
27. 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
Coordinated Coverage
claim
complience plan
Experimental Procedures
28. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
e-health information management
Individually identifiable health information
Notice of Privacy Practices
epo
29. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
claim
Network
(PCN) Primary Care Network
complience
30. 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
covered entity
consulting physician
(AOB) Assignment of Benefits
clearinghouse
31. A health insurance enrollee chooses to see an out of network provider without authorization
covered entity
Protected health information
self-referral
state preemption
32. Health Information Portability and Accountability Act
(TPA) Third Party Administrator
HIPAA
fraud
Privacy officer
33. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Consent form
security officer
(PCN) Primary Care Network
34. The amount of actual money available to the medical practice
Pre-existing Condition Exclusion
cash flow
electronic media
electronic media
35. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Privileged information
(ERISA) Employee Retirement Income Security Act of 1974
HIPAA
(DCI) Duplicate Coverage Inquiry
36. 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
(ABN) Advance Beneficiary Notice
abuse
nonprivileged information
37. 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
Open Enrollment
nonprivileged information
Participating Provider
Confidential communication
38. A nonprofit integrated delivery system
HIPAA
Preauthorization
Claim
medical foundation
39. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
Claim
(DCI) Duplicate Coverage Inquiry
(Non-par) Non-Participating Provider
40. 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
prepaid plan
Privacy officer
Network
(COBRA)
41. American Medical Association
Participating Provider
AMA
health care provider
(EPO) Exclusive Provider Organization
42. Medical staff member who is legally responsible for the care and treatment given to a patient.
medical foundation
(COB) Coordination of Benefits
Pre-existing Condition Exclusion
attending physician
43. 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
Security Rule
Out of Network (OON)
(AOB) Assignment of Benefits
44. 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
Privileged information
Pre-existing Condition Exclusion
Open Enrollment
Claim
45. 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
(POS) Point-of Service Plan
Protected health information
Maximum Out Of Pocket
prepaid plan
46. 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.
abuse
(DCI) Duplicate Coverage Inquiry
(POS) Point-of Service Plan
Privacy officer
47. 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
hmo
(PCP) Primary Care Physician
(PEC) Pre-existing condition
(DCI) Duplicate Coverage Inquiry
48. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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49. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
crossover claim
deductible
epo
50. 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
(Non-par) Non-Participating Provider
claim
Embezzlement
(DME) Durable Medical Equipment