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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. The amount of actual money available to the medical practice
ee schedule
(AOB) Assignment of Benefits
cash flow
disclosure
2. The maximum amount a plan pays for a covered service
Allowed Expenses
authorization form
consulting physician
benefit period
3. A list of the amount to be paid by an insurance company for each procedure service
Confidential communication
ee schedule
prepaid plan
abuse
4. 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
Pre-certification
benefit period
(ABN) Advance Beneficiary Notice
referral
5. A willful act by an employee of taking possession of an employer's money
Referral
Embezzlement
complience plan
Protected health information
6. A patient claim is eligible for medicare and medicaid
covered entity
Allowed Expenses
crossover claim
complience
7. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
privacy
Individually identifiable health information
Allowed Expenses
8. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
etiquette
(AOB) Assignment of Benefits
Referral
e-health information management
9. The period of time that payment for Medicare inpatient hospital benefits are available
preauthorization
benefit period
Treating or performing physician
Standard
10. American Medical Association
pcp
clearinghouse
Privacy officer
AMA
11. 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)
(COB) Coordination of Benefits
preauthorization
Consent form
Confidential communication
12. 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
disclosure
(POS) Point-of Service Plan
Maximum Out Of Pocket
phantom billing
13. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Beneficiary
confidentiality
Pre-certification
abuse
14. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
epo
(EPO) Exclusive Provider Organization
crossover claim
state preemption
15. Billing for services not performed
Security Rule
complience plan
phantom billing
(ABN) Advance Beneficiary Notice
16. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
breach of confidential communication
privacy
preauthorization
confidentiality
17. 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
Individually identifiable health information
(PPS) Hospital Impatient Prospective Payment System
covered entity
Sub-acute Care
18. Individually identifiable health information
premium
IIHI
(PCP) Primary Care Physician
Amblatory Care
19. 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
authorization form
self-referral
clearinghouse
pos
20. 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
ee schedule
(POS) Point-of Service Plan
confidentiality
(ABN) Advance Beneficiary Notice
21. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Assignment & Authorization
premium
(APC) Ambulatory Patient Classifications
(OOPs) Out of Pocket Costs/Expenses
22. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Preauthorization
clearinghouse
Deductible
(Non-par) Non-Participating Provider
23. 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
Experimental Procedures
Referral
Preauthorization
Consent form
24. 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
consulting physician
Pre-certification
Sub-acute Care
Privacy officer
25. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
fraud
Network
claim
disclosure
26. A willful act by an employee of taking possession of an employer's money
Embezzlement
Treating or performing physician
prepaid plan
(PAC) Pre- Admission Certification
27. The period of time that payment for Medicare inpatient hospital benefits are available
referral
attending physician
Pre-certification
benefit period
28. A nonprofit integrated delivery system
pos
medical foundation
(AOB) Assignment of Benefits
consent
29. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Assignment & Authorization
closed panel HMO
(DCI) Duplicate Coverage Inquiry
30. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Confidential communication
(TPA) Third Party Administrator
(PAC) Pre- Admission Certification
Referral
31. 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.
(AOB) Assignment of Benefits
security officer
(COBRA)
Subscriber
32. The transmission of information between two parties to carry out financial or administrative activities related to health care.
abuse
transaction
authorization form
(PAC) Pre- Admission Certification
33. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
referring physician
(PCN) Primary Care Network
self-referral
ppo
34. 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
econdary Payer
(UR) Utilization review
health care provider
(COBRA)
35. An organization of provider sites with a contracted relationship that offer services
Deductible
consulting physician
Privileged information
ids
36. Standards of conduct generally accepted as a moral guide for behavior.
breach of confidential communication
ethics
complience
Out of Network (OON)
37. The amount of actual money available to the medical practice
cash flow
(PCP) Primary Care Physician
Amblatory Care
Individually identifiable health information
38. 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
(ERISA) Employee Retirement Income Security Act of 1974
Assignment & Authorization
hmo
(PCN) Primary Care Network
39. 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
complience
(PEC) Pre-existing condition
subscriber
40. 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
breach of confidential communication
nonprivileged information
ppo
Pre-certification
41. Someone who is eligible for or receiving benefits under an insurance policy or plan
abuse
prepaid plan
Beneficiary
pos
42. 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
Supplementary Medical Insurance
(PEC) Pre-existing condition
Experimental Procedures
43. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Privileged information
Pre-certification
Network
Beneficiary
44. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
Supplementary Medical Insurance
state preemption
consulting physician
breach of confidential communication
45. Health Information Portability and Accountability Act
(DCI) Duplicate Coverage Inquiry
(UR) Utilization review
preauthorization
HIPAA
46. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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47. 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.
Notice of Privacy Practices
Supplementary Medical Insurance
etiquette
Allowed Expenses
48. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
etiquette
crossover claim
ordering physician
Treating or performing physician
49. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Claim
e-health information management
Confidential communication
Individually identifiable health information
50. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Medigap Insurance
(TPA) Third Party Administrator
(DME) Durable Medical Equipment
(POS) Point-of Service Plan