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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. 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.
phantom billing
Notice of Privacy Practices
(UR) Utilization review
(Non-par) Non-Participating Provider
2. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
premium
Covered Expenses
fraud
3. The maximum amount a plan pays for a covered service
Allowed Expenses
consulting physician
(COBRA)
(PPS) Hospital Impatient Prospective Payment System
4. A monthly fee paid by the insured for specific medical insurance coverage
premium
ids
(Non-par) Non-Participating Provider
complience plan
5. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Privacy officer
AMA
Referral
nonprivileged information
6. 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
Privacy officer
epo
Standard
7. 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
Amblatory Care
covered entity
fraud
8. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
prepaid plan
claim
(PPS) Hospital Impatient Prospective Payment System
Subscriber
9. The dates of healthcare services were provided to the beneficiary
benefit period
(DOS) Date of Service
hmo
AMA
10. 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
Standard
e-health information management
open panel HMO
11. A willful act by an employee of taking possession of an employer's money
(DCI) Duplicate Coverage Inquiry
pos
Embezzlement
transaction
12. 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
(DOS) Date of Service
Pre-existing Condition Exclusion
econdary Payer
13. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
ethics
abuse
Allowed Expenses
privacy
14. An intentional misrepresentation of the facts to deceive or mislead another.
(TPA) Third Party Administrator
fraud
deductible
Pre-existing Condition Exclusion
15. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Notice of Privacy Practices
consent
Privacy officer
16. 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.
(APC) Ambulatory Patient Classifications
complience plan
health care provider
Participating Provider
17. 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
nonprivileged information
Deductible
e-health information management
(AOB) Assignment of Benefits
18. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
electronic media
Pre-certification
(APC) Ambulatory Patient Classifications
hmo
19. 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.
ppo
closed panel HMO
security officer
Resonable Charge
20. American Medical Association
complience plan
AMA
phantom billing
Referral
21. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
subscriber
clearinghouse
Network
privacy
22. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
consulting physician
(APC) Ambulatory Patient Classifications
nonprivileged information
transaction
23. 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
self-referral
(PAC) Pre- Admission Certification
(PCN) Primary Care Network
AMA
24. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
benefit period
Maximum Out Of Pocket
complience plan
Out of Network (OON)
25. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Open Enrollment
Coordinated Coverage
(POS) Point-of Service Plan
(UCR) Usual - Customary and Reasonable
26. 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
authorization form
Standard
Standard
(PPS) Hospital Impatient Prospective Payment System
27. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
privacy
Participating Provider
Preauthorization
28. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan
Pre-existing Condition Exclusion
Coordinated Coverage
Participating Provider
(PAC) Pre- Admission Certification
29. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
consent
Referral
ee schedule
30. 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
referral
Medigap Insurance
covered entity
(PCP) Primary Care Physician
31. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Subscriber
phantom billing
pcp
(PCN) Primary Care Network
32. A provision that apples when a person is covered under more than one group medical program
state preemption
(COB) Coordination of Benefits
fraud
etiquette
33. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Subscriber
abuse
(UR) Utilization review
34. 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
Allowed Expenses
(DME) Durable Medical Equipment
Protected health information
(PCP) Primary Care Physician
35. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Sub-acute Care
(OOPs) Out of Pocket Costs/Expenses
(ERISA) Employee Retirement Income Security Act of 1974
e-health information management
36. 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)
(Non-par) Non-Participating Provider
Consent form
ordering physician
medical foundation
37. 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.
disclosure
epo
state preemption
prepaid plan
38. 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
medical foundation
authorization form
(OOPs) Out of Pocket Costs/Expenses
(Non-par) Non-Participating Provider
39. 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
Preauthorization
ethics
Coordinated Coverage
pos
40. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Standard
electronic media
privacy
pos
41. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
electronic media
Allowed Expenses
attending physician
42. 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.
(EPO) Exclusive Provider Organization
business associate
Coordinated Coverage
Standard
43. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Pre-certification
ordering physician
(UCR) Usual - Customary and Reasonable
Resonable Charge
44. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
45. A list of the amount to be paid by an insurance company for each procedure service
pcp
ee schedule
Experimental Procedures
Protected health information
46. 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
(COB) Coordination of Benefits
Coordinated Coverage
prepaid plan
authorization form
47. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Pre-existing Condition Exclusion
Embezzlement
referral
(COB) Coordination of Benefits
48. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
HIPAA
(PAC) Pre- Admission Certification
ids
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.
Individually identifiable health information
clearinghouse
hmo
open panel HMO
50. The dates of healthcare services were provided to the beneficiary
Covered Expenses
ethics
(DOS) Date of Service
Medigap Insurance