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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. 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
authorization form
preauthorization
authorization form
2. Someone who is eligible for or receiving benefits under an insurance policy or plan
(APC) Ambulatory Patient Classifications
Beneficiary
(PCP) Primary Care Physician
Standard
3. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
disclosure
ordering physician
Network
Covered Expenses
4. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
e-health information management
Preauthorization
Maximum Out Of Pocket
security officer
5. A privileged communication that may be disclosed only with the patient's permission.
Treating or performing physician
Deductible
(TPA) Third Party Administrator
Confidential communication
6. A clinic that is owned by the HMO and the physicians are employees of the HMO
Specialist
closed panel HMO
econdary Payer
(PAC) Pre- Admission Certification
7. 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
(DME) Durable Medical Equipment
attending physician
consent
(ABN) Advance Beneficiary Notice
8. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
breach of confidential communication
Privileged information
abuse
Beneficiary
9. Medicare's method of paying acute care hospitals for inpatient care
Privacy officer
(PPS) Hospital Impatient Prospective Payment System
(Non-par) Non-Participating Provider
ppo
10. 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
Covered Expenses
hmo
pos
ppo
11. A health insurance enrollee chooses to see an out of network provider without authorization
(ERISA) Employee Retirement Income Security Act of 1974
Pre-existing Condition Exclusion
self-referral
covered entity
12. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consent
consulting physician
Notice of Privacy Practices
ee schedule
13. 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
Preauthorization
(DME) Durable Medical Equipment
fraud
consulting physician
14. 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.
benefit period
Resonable Charge
business associate
Beneficiary
15. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(DME) Durable Medical Equipment
breach of confidential communication
e-health information management
state preemption
16. 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
Resonable Charge
open panel HMO
state preemption
17. The period of time that payment for Medicare inpatient hospital benefits are available
epo
(PAC) Pre- Admission Certification
ids
benefit period
18. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
Assignment & Authorization
(PCP) Primary Care Physician
covered entity
19. 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
nonprivileged information
(APC) Ambulatory Patient Classifications
Deductible
ppo
20. 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
covered entity
Security Rule
Referral
e-health information management
21. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
self-referral
HIPAA
complience
(TPA) Third Party Administrator
22. Standards of conduct generally accepted as a moral guide for behavior.
(DOS) Date of Service
Medigap Insurance
Pre-existing Condition Exclusion
ethics
23. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(PAC) Pre- Admission Certification
ethics
(DCI) Duplicate Coverage Inquiry
Participating Provider
24. A list of the amount to be paid by an insurance company for each procedure service
(COB) Coordination of Benefits
self-referral
Medigap Insurance
ee schedule
25. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
Out of Network (OON)
(PEC) Pre-existing condition
(PAC) Pre- Admission Certification
claim
26. 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
Treating or performing physician
attending physician
subscriber
27. Integrating benefits payable under more than one health insurance.
prepaid plan
Sub-acute Care
pos
Coordinated Coverage
28. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Privileged information
(DRG's)
Individually identifiable health information
pos
29. 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
abuse
Resonable Charge
Preauthorization
Experimental Procedures
30. Customs - rules of conduct - courtesy - and manners of the medical profession
transaction
attending physician
etiquette
Beneficiary
31. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Subscriber
ordering physician
Assignment & Authorization
ids
32. 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
(COBRA)
Covered Expenses
(APC) Ambulatory Patient Classifications
(PCP) Primary Care Physician
33. 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
(EPO) Exclusive Provider Organization
(PEC) Pre-existing condition
(COBRA)
ppo
34. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(PAC) Pre- Admission Certification
(UCR) Usual - Customary and Reasonable
Privileged information
Network
35. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Standard
(PAC) Pre- Admission Certification
prepaid plan
36. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
state preemption
Medigap Insurance
attending physician
Out of Network (OON)
37. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
state preemption
nonprivileged information
electronic media
Privacy officer
38. A provision that apples when a person is covered under more than one group medical program
pos
complience plan
(EPO) Exclusive Provider Organization
(COB) Coordination of Benefits
39. 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
(POS) Point-of Service Plan
(ERISA) Employee Retirement Income Security Act of 1974
cash flow
40. 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.
(PEC) Pre-existing condition
security officer
(AOB) Assignment of Benefits
clearinghouse
41. Unauthorized release of information
Preauthorization
Network
breach of confidential communication
Claim
42. An intentional misrepresentation of the facts to deceive or mislead another.
Coordinated Coverage
(PEC) Pre-existing condition
ids
fraud
43. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
complience
(UR) Utilization review
econdary Payer
44. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
complience
Maximum Out Of Pocket
cash flow
45. 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
(PCN) Primary Care Network
consulting physician
Standard
(PPS) Hospital Impatient Prospective Payment System
46. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
authorization form
Resonable Charge
(DOS) Date of Service
AMA
47. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Experimental Procedures
(Non-par) Non-Participating Provider
Consent form
48. 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
referral
(PAC) Pre- Admission Certification
pcp
(PCN) Primary Care 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
complience
closed panel HMO
clearinghouse
50. The condition of being secluded from the presence or view of others.
Subscriber
consulting physician
medical foundation
privacy