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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 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
breach of confidential communication
complience plan
benefit period
epo
2. The condition of being secluded from the presence or view of others.
disclosure
nonprivileged information
privacy
ethics
3. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
pcp
claim
(DCI) Duplicate Coverage Inquiry
Subscriber
4. A rule - condition - or requirement
Pre-certification
Standard
(TPA) Third Party Administrator
health care provider
5. 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
Standard
Specialist
closed panel HMO
prepaid plan
6. Integrating benefits payable under more than one health insurance.
consent
Coordinated Coverage
Claim
(DRG's)
7. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(UR) Utilization review
(APC) Ambulatory Patient Classifications
disclosure
etiquette
8. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
security officer
AMA
(DME) Durable Medical Equipment
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
IIHI
ids
Supplementary Medical Insurance
10. 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
Embezzlement
Privileged information
Covered Expenses
11. The maximum amount a plan pays for a covered service
health care provider
Allowed Expenses
consulting physician
Resonable Charge
12. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
consent
preauthorization
pos
breach of confidential communication
13. Billing for services not performed
phantom billing
(TPA) Third Party Administrator
(ABN) Advance Beneficiary Notice
abuse
14. An intentional misrepresentation of the facts to deceive or mislead another.
Protected health information
pcp
Deductible
fraud
15. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
IIHI
AMA
Sub-acute Care
abuse
16. A structure for classifying outpatient services and procedures for purpose of payment
deductible
Individually identifiable health information
(APC) Ambulatory Patient Classifications
ethics
17. 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)
Referral
hmo
Consent form
nonprivileged information
18. 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
electronic media
nonprivileged information
medical foundation
(UR) Utilization review
19. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(COBRA)
(DCI) Duplicate Coverage Inquiry
Resonable Charge
(EPO) Exclusive Provider Organization
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
(ABN) Advance Beneficiary Notice
Participating Provider
attending physician
state preemption
21. 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
Confidential communication
preauthorization
etiquette
22. 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
nonprivileged information
Embezzlement
(PCP) Primary Care Physician
abuse
23. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(DME) Durable Medical Equipment
open panel HMO
prepaid plan
Subscriber
24. American Medical Association
AMA
breach of confidential communication
referring physician
Confidential communication
25. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Subscriber
Medigap Insurance
(PAC) Pre- Admission Certification
Privileged information
26. 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
(POS) Point-of Service Plan
ordering physician
Experimental Procedures
e-health information management
27. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Out of Network (OON)
Network
complience plan
28. Unauthorized release of information
cash flow
Privileged information
(PEC) Pre-existing condition
breach of confidential communication
29. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
benefit period
Consent form
transaction
30. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
IIHI
Experimental Procedures
covered entity
31. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Pre-existing Condition Exclusion
prepaid plan
consulting physician
Standard
32. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
clearinghouse
open panel HMO
subscriber
Individually identifiable health information
33. 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
Individually identifiable health information
e-health information management
Pre-existing Condition Exclusion
security officer
34. The dates of healthcare services were provided to the beneficiary
pos
Individually identifiable health information
(DOS) Date of Service
Out of Network (OON)
35. The transmission of information between two parties to carry out financial or administrative activities related to health care.
AMA
Experimental Procedures
transaction
Embezzlement
36. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Referral
Notice of Privacy Practices
ee schedule
37. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
38. Individually identifiable health information
health care provider
IIHI
closed panel HMO
(DCI) Duplicate Coverage Inquiry
39. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
crossover claim
Pre-certification
pos
(OOPs) Out of Pocket Costs/Expenses
40. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(PPS) Hospital Impatient Prospective Payment System
Experimental Procedures
ethics
41. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(PCP) Primary Care Physician
health care provider
pcp
transaction
42. The period of time that payment for Medicare inpatient hospital benefits are available
attending physician
Privacy officer
(DRG's)
benefit period
43. 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
(OOPs) Out of Pocket Costs/Expenses
consulting physician
Deductible
Experimental Procedures
44. A clinic that is owned by the HMO and the physicians are employees of the HMO
privacy
closed panel HMO
(PPS) Hospital Impatient Prospective Payment System
IIHI
45. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Coordinated Coverage
attending physician
referring physician
46. 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
(EPO) Exclusive Provider Organization
(PAC) Pre- Admission Certification
(PCN) Primary Care Network
47. 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
Amblatory Care
Specialist
pos
security officer
48. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
state preemption
subscriber
Protected health information
Network
49. 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
disclosure
(DME) Durable Medical Equipment
(PEC) Pre-existing condition
50. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
(OOPs) Out of Pocket Costs/Expenses
Coordinated Coverage
pos