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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. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Supplementary Medical Insurance
closed panel HMO
preauthorization
(DOS) Date of Service
2. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated
Resonable Charge
Privileged information
Pre-existing Condition Exclusion
(PEC) Pre-existing condition
3. 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
HIPAA
(ABN) Advance Beneficiary Notice
ppo
ethics
4. 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.
econdary Payer
Participating Provider
(COB) Coordination of Benefits
health care provider
5. Individually identifiable health information
IIHI
security officer
Network
HIPAA
6. Billing for services not performed
deductible
Preauthorization
phantom billing
state preemption
7. Health Information Portability and Accountability Act
Privacy officer
privacy
Referral
HIPAA
8. 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.
transaction
(PPS) Hospital Impatient Prospective Payment System
Treating or performing physician
state preemption
9. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Beneficiary
Referral
econdary Payer
(APC) Ambulatory Patient Classifications
10. 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
Subscriber
Embezzlement
Confidential communication
11. Medical staff member who is legally responsible for the care and treatment given to a patient.
ethics
Security Rule
phantom billing
attending physician
12. 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
Privileged information
consent
Experimental Procedures
cash flow
13. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
clearinghouse
Specialist
ids
Individually identifiable health information
14. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Consent form
confidentiality
Open Enrollment
health care provider
15. A review of the need for inpatient hospital care - completed before the actual admission
(DME) Durable Medical Equipment
Protected health information
Open Enrollment
(PAC) Pre- Admission Certification
16. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Assignment & Authorization
Consent form
(UCR) Usual - Customary and Reasonable
Medigap Insurance
17. 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
security officer
ethics
Notice of Privacy Practices
18. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Beneficiary
consulting physician
self-referral
privacy
19. What the insurance company will consider paying for as defined in the contract.
authorization form
(DRG's)
Covered Expenses
crossover claim
20. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
health care provider
clearinghouse
(COB) Coordination of Benefits
Resonable Charge
21. 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.
Participating Provider
epo
IIHI
health care provider
22. 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)
breach of confidential communication
Consent form
complience
fraud
23. 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
Supplementary Medical Insurance
electronic media
benefit period
medical foundation
24. 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
Participating Provider
Beneficiary
Individually identifiable health information
Notice of Privacy Practices
25. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
abuse
electronic media
e-health information management
Resonable Charge
26. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Specialist
e-health information management
Treating or performing physician
Medigap Insurance
27. 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
closed panel HMO
Sub-acute Care
etiquette
fraud
28. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Pre-certification
(AOB) Assignment of Benefits
transaction
pcp
29. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(POS) Point-of Service Plan
Standard
electronic media
(DOS) Date of Service
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
(DRG's)
abuse
(AOB) Assignment of Benefits
clearinghouse
31. A clinic that is owned by the HMO and the physicians are employees of the HMO
(PPS) Hospital Impatient Prospective Payment System
Experimental Procedures
closed panel HMO
consulting physician
32. 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
ethics
Participating Provider
Security Rule
ids
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
referring physician
(COBRA)
prepaid plan
Amblatory Care
34. 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
(ERISA) Employee Retirement Income Security Act of 1974
Consent form
complience
prepaid plan
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
Covered Expenses
Resonable Charge
(DCI) Duplicate Coverage Inquiry
referring physician
36. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Privacy officer
(UCR) Usual - Customary and Reasonable
Confidential communication
prepaid plan
37. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(UR) Utilization review
referral
ee schedule
confidentiality
38. 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
ordering physician
deductible
nonprivileged information
(PCN) Primary Care Network
39. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Supplementary Medical Insurance
clearinghouse
(COB) Coordination of Benefits
benefit period
40. 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
(OOPs) Out of Pocket Costs/Expenses
(DOS) Date of Service
etiquette
41. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Treating or performing physician
(DCI) Duplicate Coverage Inquiry
hmo
confidentiality
42. A monthly fee paid by the insured for specific medical insurance coverage
Preauthorization
Maximum Out Of Pocket
premium
attending physician
43. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
etiquette
(TPA) Third Party Administrator
complience plan
premium
44. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Preauthorization
Notice of Privacy Practices
(PPS) Hospital Impatient Prospective Payment System
45. Standards of conduct generally accepted as a moral guide for behavior.
ethics
phantom billing
disclosure
Medigap Insurance
46. An organization of provider sites with a contracted relationship that offer services
(COB) Coordination of Benefits
Standard
pcp
ids
47. American Medical Association
Out of Network (OON)
(DRG's)
AMA
Referral
48. Standards of conduct generally accepted as a moral guide for behavior.
Embezzlement
Protected health information
ethics
Notice of Privacy Practices
49. Someone who is eligible for or receiving benefits under an insurance policy or plan
pos
(APC) Ambulatory Patient Classifications
Beneficiary
(PCP) Primary Care Physician
50. Is the provider who renders a service to a patient
Participating Provider
Pre-existing Condition Exclusion
Treating or performing physician
fraud