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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. Health Information Portability and Accountability Act
Treating or performing physician
medical foundation
HIPAA
IIHI
2. American Medical Association
(PPS) Hospital Impatient Prospective Payment System
authorization form
AMA
(UCR) Usual - Customary and Reasonable
3. Verbal or written agreement that gives approval to some action - situation - or statement.
Covered Expenses
clearinghouse
consent
ee schedule
4. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
open panel HMO
Confidential communication
e-health information management
electronic media
5. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Subscriber
disclosure
nonprivileged information
(TPA) Third Party Administrator
6. 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
Security Rule
ppo
Open Enrollment
(UCR) Usual - Customary and Reasonable
7. A patient claim is eligible for medicare and medicaid
Standard
(COB) Coordination of Benefits
Supplementary Medical Insurance
crossover claim
8. Unauthorized release of information
Network
Participating Provider
breach of confidential communication
pos
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
Standard
(UR) Utilization review
(POS) Point-of Service Plan
10. 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
Deductible
consulting physician
claim
(PPS) Hospital Impatient Prospective Payment System
11. 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
deductible
(COBRA)
transaction
12. A review of the need for inpatient hospital care - completed before the actual admission
econdary Payer
nonprivileged information
(PAC) Pre- Admission Certification
pos
13. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Standard
Medigap Insurance
referral
(OOPs) Out of Pocket Costs/Expenses
14. Billing for services not performed
phantom billing
(ERISA) Employee Retirement Income Security Act of 1974
Individually identifiable health information
etiquette
15. 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
Specialist
(Non-par) Non-Participating Provider
fraud
referring physician
16. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
referral
covered entity
complience plan
consent
17. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Out of Network (OON)
prepaid plan
(PAC) Pre- Admission Certification
18. 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
Assignment & Authorization
Confidential communication
closed panel HMO
Maximum Out Of Pocket
19. A patient claim is eligible for medicare and medicaid
crossover claim
covered entity
Consent form
Privileged information
20. 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
Notice of Privacy Practices
Subscriber
(PCP) Primary Care Physician
attending physician
21. 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
privacy
Privacy officer
covered entity
Security Rule
22. 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
Covered Expenses
epo
Supplementary Medical Insurance
authorization form
23. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
fraud
Subscriber
state preemption
24. Health Information Portability and Accountability Act
HIPAA
Notice of Privacy Practices
Open Enrollment
privacy
25. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
(DME) Durable Medical Equipment
AMA
IIHI
26. 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.
Referral
security officer
consulting physician
Embezzlement
27. 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
Maximum Out Of Pocket
Privileged information
etiquette
Embezzlement
28. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
(DRG's)
ee schedule
open panel HMO
health care provider
29. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Medigap Insurance
Privacy officer
Pre-certification
(DCI) Duplicate Coverage Inquiry
30. 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
AMA
(AOB) Assignment of Benefits
state preemption
Experimental Procedures
31. 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
Coordinated Coverage
open panel HMO
Deductible
covered entity
32. Verbal or written agreement that gives approval to some action - situation - or statement.
fraud
consent
state preemption
(ERISA) Employee Retirement Income Security Act of 1974
33. A review of the need for inpatient hospital care - completed before the actual admission
transaction
(Non-par) Non-Participating Provider
Maximum Out Of Pocket
(PAC) Pre- Admission Certification
34. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
consulting physician
claim
electronic media
(EPO) Exclusive Provider Organization
35. 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
preauthorization
security officer
medical foundation
36. 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
e-health information management
Sub-acute Care
Individually identifiable health information
(TPA) Third Party Administrator
37. A rule - condition - or requirement
Standard
Amblatory Care
hmo
(DME) Durable Medical Equipment
38. 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
pos
ppo
ordering physician
consent
39. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
claim
(APC) Ambulatory Patient Classifications
prepaid plan
Subscriber
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
Out of Network (OON)
covered entity
cash flow
ids
41. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Protected health information
Individually identifiable health information
Specialist
42. The amount of actual money available to the medical practice
crossover claim
cash flow
(UCR) Usual - Customary and Reasonable
deductible
43. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
Privileged information
Experimental Procedures
consent
(COBRA)
44. A monthly fee paid by the insured for specific medical insurance coverage
premium
fraud
Deductible
Referral
45. A list of the amount to be paid by an insurance company for each procedure service
Medigap Insurance
closed panel HMO
ee schedule
subscriber
46. 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
(UR) Utilization review
benefit period
(ABN) Advance Beneficiary Notice
deductible
47. Billing for services not performed
phantom billing
ethics
prepaid plan
(COB) Coordination of Benefits
48. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
benefit period
(DRG's)
breach of confidential communication
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.
e-health information management
security officer
(POS) Point-of Service Plan
health care provider
50. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
etiquette
fraud
claim
premium
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