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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. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Pre-certification
(EPO) Exclusive Provider Organization
nonprivileged information
2. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
(PEC) Pre-existing condition
(ABN) Advance Beneficiary Notice
(COBRA)
3. Is the provider who renders a service to a patient
Treating or performing physician
prepaid plan
(PAC) Pre- Admission Certification
Referral
4. Verbal or written agreement that gives approval to some action - situation - or statement.
(ABN) Advance Beneficiary Notice
Privacy officer
consent
referral
5. A monthly fee paid by the insured for specific medical insurance coverage
Resonable Charge
HIPAA
Confidential communication
premium
6. 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
privacy
Security Rule
phantom billing
(COBRA)
7. A willful act by an employee of taking possession of an employer's money
Embezzlement
(DRG's)
referring physician
(UCR) Usual - Customary and Reasonable
8. Medical services provided on an outpatient basis
fraud
Amblatory Care
(ABN) Advance Beneficiary Notice
(ABN) Advance Beneficiary Notice
9. An organization of provider sites with a contracted relationship that offer services
ids
hmo
Subscriber
Open Enrollment
10. 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
(Non-par) Non-Participating Provider
Beneficiary
(UR) Utilization review
(APC) Ambulatory Patient Classifications
11. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
state preemption
Individually identifiable health information
complience plan
(ABN) Advance Beneficiary Notice
12. Integrating benefits payable under more than one health insurance.
referral
Coordinated Coverage
Allowed Expenses
complience plan
13. A nonprofit integrated delivery system
referring physician
breach of confidential communication
confidentiality
medical foundation
14. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
medical foundation
complience plan
business associate
15. 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.
Notice of Privacy Practices
attending physician
Confidential communication
security officer
16. 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
Specialist
(ERISA) Employee Retirement Income Security Act of 1974
17. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Pre-existing Condition Exclusion
electronic media
Covered Expenses
Medigap Insurance
18. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
clearinghouse
claim
Embezzlement
security officer
19. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
preauthorization
complience
(UCR) Usual - Customary and Reasonable
hmo
20. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(DOS) Date of Service
Open Enrollment
Medigap Insurance
21. 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
claim
Treating or performing physician
pos
complience plan
22. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(DME) Durable Medical Equipment
Referral
Amblatory Care
Pre-certification
23. 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
(COBRA)
Pre-certification
Maximum Out Of Pocket
Standard
24. A provision that apples when a person is covered under more than one group medical program
Privileged information
(DOS) Date of Service
(COB) Coordination of Benefits
Privacy officer
25. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
claim
preauthorization
Security Rule
phantom billing
26. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
security officer
referral
IIHI
Pre-certification
27. 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
econdary Payer
(EPO) Exclusive Provider Organization
disclosure
cash flow
28. 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
Sub-acute Care
(DOS) Date of Service
(POS) Point-of Service Plan
Open Enrollment
29. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Beneficiary
subscriber
electronic media
30. 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
hmo
(PCN) Primary Care Network
consent
Resonable Charge
31. Integrating benefits payable under more than one health insurance.
clearinghouse
preauthorization
business associate
Coordinated Coverage
32. 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.
(APC) Ambulatory Patient Classifications
Out of Network (OON)
(PPS) Hospital Impatient Prospective Payment System
business associate
33. 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
(AOB) Assignment of Benefits
Standard
state preemption
Out of Network (OON)
34. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Preauthorization
claim
breach of confidential communication
Pre-certification
35. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(PCN) Primary Care Network
(PCP) Primary Care Physician
(COB) Coordination of Benefits
Resonable Charge
36. Unauthorized release of information
self-referral
(PPS) Hospital Impatient Prospective Payment System
Confidential communication
breach of confidential communication
37. 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
Protected health information
Open Enrollment
premium
(COB) Coordination of Benefits
38. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
IIHI
(COBRA)
(PCP) Primary Care Physician
clearinghouse
39. 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
Amblatory Care
(DME) Durable Medical Equipment
breach of confidential communication
complience
40. 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
covered entity
(Non-par) Non-Participating Provider
Referral
41. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
referral
Allowed Expenses
ethics
(DCI) Duplicate Coverage Inquiry
42. A nonprofit integrated delivery system
medical foundation
(EPO) Exclusive Provider Organization
privacy
benefit period
43. A rule - condition - or requirement
Open Enrollment
Standard
Covered Expenses
Allowed Expenses
44. 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
Medigap Insurance
(Non-par) Non-Participating Provider
electronic media
Beneficiary
45. A list of the amount to be paid by an insurance company for each procedure service
Privacy officer
abuse
e-health information management
ee schedule
46. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
Medigap Insurance
Specialist
(AOB) Assignment of Benefits
47. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
confidentiality
ordering physician
ee schedule
48. 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
(PCP) Primary Care Physician
etiquette
HIPAA
Out of Network (OON)
49. 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
health care provider
ppo
benefit period
(EPO) Exclusive Provider Organization
50. 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
Covered Expenses
prepaid plan
Medigap Insurance
closed panel HMO