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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. 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
cash flow
claim
ordering physician
econdary Payer
2. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Pre-certification
phantom billing
preauthorization
Maximum Out Of Pocket
3. A provision that apples when a person is covered under more than one group medical program
medical foundation
(PPS) Hospital Impatient Prospective Payment System
(COB) Coordination of Benefits
state preemption
4. 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
Maximum Out Of Pocket
referral
(PCP) Primary Care Physician
complience
5. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
business associate
(OOPs) Out of Pocket Costs/Expenses
(PAC) Pre- Admission Certification
medical foundation
6. 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
Security Rule
(DME) Durable Medical Equipment
Preauthorization
(PEC) Pre-existing condition
7. 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
attending physician
confidentiality
(PEC) Pre-existing condition
prepaid plan
8. 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
nonprivileged information
Experimental Procedures
Protected health information
IIHI
9. 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
(AOB) Assignment of Benefits
(TPA) Third Party Administrator
AMA
nonprivileged information
10. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
Beneficiary
hmo
Privacy officer
11. Verbal or written agreement that gives approval to some action - situation - or statement.
disclosure
(POS) Point-of Service Plan
consent
ppo
12. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Open Enrollment
Maximum Out Of Pocket
referral
ordering physician
13. 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
Treating or performing physician
Pre-existing Condition Exclusion
Coordinated Coverage
ethics
14. A privileged communication that may be disclosed only with the patient's permission.
transaction
Amblatory Care
Treating or performing physician
Confidential communication
15. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Notice of Privacy Practices
Subscriber
claim
(TPA) Third Party Administrator
16. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Notice of Privacy Practices
(POS) Point-of Service Plan
hmo
17. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Subscriber
complience plan
covered entity
HIPAA
18. An organization of provider sites with a contracted relationship that offer services
Pre-existing Condition Exclusion
(UCR) Usual - Customary and Reasonable
electronic media
ids
19. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
IIHI
disclosure
Standard
Referral
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
ethics
deductible
Participating Provider
AMA
21. 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.
Security Rule
Amblatory Care
consulting physician
Protected 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
Embezzlement
disclosure
Sub-acute Care
(ERISA) Employee Retirement Income Security Act of 1974
23. 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.
Supplementary Medical Insurance
Privileged information
clearinghouse
electronic media
24. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Open Enrollment
(UR) Utilization review
(POS) Point-of Service Plan
Pre-certification
25. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(DOS) Date of Service
referral
econdary Payer
Embezzlement
26. Customs - rules of conduct - courtesy - and manners of the medical profession
Network
etiquette
Treating or performing physician
preauthorization
27. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
(COB) Coordination of Benefits
hmo
(Non-par) Non-Participating Provider
28. 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)
Covered Expenses
state preemption
ppo
Consent form
29. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Privacy officer
pcp
(AOB) Assignment of Benefits
hmo
30. 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
clearinghouse
closed panel HMO
(DCI) Duplicate Coverage Inquiry
31. A rule - condition - or requirement
subscriber
Standard
epo
etiquette
32. 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
Standard
Assignment & Authorization
state preemption
Preauthorization
33. 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
Security Rule
Supplementary Medical Insurance
ordering physician
Participating Provider
34. A privileged communication that may be disclosed only with the patient's permission.
IIHI
Confidential communication
IIHI
(Non-par) Non-Participating Provider
35. Individually identifiable health information
IIHI
Preauthorization
Notice of Privacy Practices
AMA
36. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
(DME) Durable Medical Equipment
Confidential communication
IIHI
37. The condition of being secluded from the presence or view of others.
Deductible
Supplementary Medical Insurance
subscriber
privacy
38. The transmission of information between two parties to carry out financial or administrative activities related to health care.
ordering physician
Embezzlement
transaction
Network
39. American Medical Association
Protected health information
complience
AMA
Preauthorization
40. A patient claim is eligible for medicare and medicaid
(ERISA) Employee Retirement Income Security Act of 1974
crossover claim
(DOS) Date of Service
(DRG's)
41. 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
preauthorization
Deductible
Treating or performing physician
Sub-acute Care
42. Integrating benefits payable under more than one health insurance.
Network
(ABN) Advance Beneficiary Notice
Coordinated Coverage
claim
43. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
attending physician
Resonable Charge
(PPS) Hospital Impatient Prospective Payment System
consulting physician
44. A structure for classifying outpatient services and procedures for purpose of payment
Experimental Procedures
Privacy officer
(APC) Ambulatory Patient Classifications
Notice of Privacy Practices
45. 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
IIHI
Network
Amblatory Care
46. Individually identifiable health information
IIHI
closed panel HMO
(COB) Coordination of Benefits
Standard
47. 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
Experimental Procedures
crossover claim
(Non-par) Non-Participating Provider
Protected health information
48. 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
HIPAA
Open Enrollment
Assignment & Authorization
Preauthorization
49. 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
Beneficiary
Confidential communication
phantom billing
Sub-acute Care
50. 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
deductible
subscriber
fraud
covered entity