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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.
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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. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
econdary Payer
complience plan
Maximum Out Of Pocket
security officer
2. 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
Treating or performing physician
electronic media
Deductible
Participating Provider
3. American Medical Association
Subscriber
electronic media
Network
AMA
4. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Pre-existing Condition Exclusion
Treating or performing physician
claim
Subscriber
5. 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
(Non-par) Non-Participating Provider
ordering physician
HIPAA
6. A health insurance enrollee chooses to see an out of network provider without authorization
Supplementary Medical Insurance
(EPO) Exclusive Provider Organization
self-referral
phantom billing
7. 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
clearinghouse
consulting physician
referring physician
8. 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
self-referral
(AOB) Assignment of Benefits
Out of Network (OON)
HIPAA
9. 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
(UR) Utilization review
phantom billing
deductible
10. 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
benefit period
(Non-par) Non-Participating Provider
authorization form
Beneficiary
11. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(PAC) Pre- Admission Certification
premium
(TPA) Third Party Administrator
etiquette
12. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
prepaid plan
Deductible
Referral
(TPA) Third Party Administrator
13. Medical services provided on an outpatient basis
security officer
Amblatory Care
(OOPs) Out of Pocket Costs/Expenses
ids
14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
referral
Deductible
consulting physician
preauthorization
15. Unauthorized release of information
Assignment & Authorization
Covered Expenses
ppo
breach of confidential communication
16. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(PEC) Pre-existing condition
pcp
(POS) Point-of Service Plan
Privileged information
17. The transmission of information between two parties to carry out financial or administrative activities related to health care.
nonprivileged information
cash flow
transaction
preauthorization
18. Integrating benefits payable under more than one health insurance.
disclosure
claim
Treating or performing physician
Coordinated Coverage
19. Individually identifiable health information
confidentiality
Privileged information
covered entity
IIHI
20. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(DME) Durable Medical Equipment
Preauthorization
claim
e-health information management
21. 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
Preauthorization
consent
etiquette
Experimental Procedures
22. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
complience
Supplementary Medical Insurance
Allowed Expenses
preauthorization
23. The maximum amount a plan pays for a covered service
Allowed Expenses
(Non-par) Non-Participating Provider
Out of Network (OON)
authorization form
24. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
medical foundation
Privileged information
(PEC) Pre-existing condition
25. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
Resonable Charge
Preauthorization
(COBRA)
consent
26. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
(PAC) Pre- Admission Certification
(ABN) Advance Beneficiary Notice
attending physician
27. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
complience
Pre-certification
Privacy officer
clearinghouse
28. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
crossover claim
Coordinated Coverage
IIHI
29. A monthly fee paid by the insured for specific medical insurance coverage
Pre-existing Condition Exclusion
(OOPs) Out of Pocket Costs/Expenses
premium
Covered Expenses
30. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(DME) Durable Medical Equipment
Privacy officer
ppo
disclosure
31. Billing for services not performed
phantom billing
ee schedule
(EPO) Exclusive Provider Organization
(AOB) Assignment of Benefits
32. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Resonable Charge
ordering physician
Network
Protected health information
33. 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
(DOS) Date of Service
deductible
complience plan
ppo
34. A review of the need for inpatient hospital care - completed before the actual admission
open panel HMO
ids
(PAC) Pre- Admission Certification
referral
35. 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
(ABN) Advance Beneficiary Notice
disclosure
(UCR) Usual - Customary and Reasonable
Amblatory Care
36. An intentional misrepresentation of the facts to deceive or mislead another.
etiquette
Participating Provider
fraud
state preemption
37. 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
Notice of Privacy Practices
(EPO) Exclusive Provider Organization
Subscriber
Maximum Out Of Pocket
38. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Out of Network (OON)
(PCP) Primary Care Physician
e-health information management
39. A list of the amount to be paid by an insurance company for each procedure service
Subscriber
Confidential communication
open panel HMO
ee schedule
40. The dates of healthcare services were provided to the beneficiary
Claim
(DOS) Date of Service
etiquette
Preauthorization
41. Integrating benefits payable under more than one health insurance.
consent
breach of confidential communication
clearinghouse
Coordinated Coverage
42. Is a provider who sends the patients for testing or treatment
(PCP) Primary Care Physician
pos
Open Enrollment
referring physician
43. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(PPS) Hospital Impatient Prospective Payment System
(ERISA) Employee Retirement Income Security Act of 1974
(EPO) Exclusive Provider Organization
(POS) Point-of Service Plan
44. A list of the amount to be paid by an insurance company for each procedure service
preauthorization
attending physician
Security Rule
ee schedule
45. 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
self-referral
Claim
(APC) Ambulatory Patient Classifications
Sub-acute Care
46. 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
electronic media
benefit period
(Non-par) Non-Participating Provider
fraud
47. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
transaction
complience
Pre-certification
Amblatory Care
48. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
epo
Resonable Charge
ee schedule
benefit period
49. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Specialist
(DOS) Date of Service
(PEC) Pre-existing condition
(UCR) Usual - Customary and Reasonable
50. 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.
Protected health information
referral
(ABN) Advance Beneficiary Notice
etiquette
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