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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. Individually identifiable health information
Sub-acute Care
(DCI) Duplicate Coverage Inquiry
IIHI
electronic media
2. 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
Network
open panel HMO
Security Rule
(DCI) Duplicate Coverage Inquiry
3. A rule - condition - or requirement
(Non-par) Non-Participating Provider
Sub-acute Care
Standard
security officer
4. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
consent
(PEC) Pre-existing condition
benefit period
Specialist
5. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Allowed Expenses
AMA
(DOS) Date of Service
subscriber
6. A patient claim is eligible for medicare and medicaid
consent
crossover claim
nonprivileged information
Claim
7. 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
electronic media
ppo
Supplementary Medical Insurance
pos
8. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Experimental Procedures
ppo
(UR) Utilization review
epo
9. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Supplementary Medical Insurance
Specialist
Out of Network (OON)
10. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Amblatory Care
epo
Specialist
premium
11. An organization of provider sites with a contracted relationship that offer services
medical foundation
ids
Network
authorization form
12. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Experimental Procedures
econdary Payer
consulting physician
ordering physician
13. 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
Experimental Procedures
(ERISA) Employee Retirement Income Security Act of 1974
privacy
Open Enrollment
14. 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
Experimental Procedures
Referral
Deductible
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.
(UCR) Usual - Customary and Reasonable
premium
Referral
security officer
16. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
crossover claim
ordering physician
Individually identifiable health information
deductible
17. 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
Treating or performing physician
premium
pos
18. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Assignment & Authorization
(PCN) Primary Care Network
crossover claim
pcp
19. A rule - condition - or requirement
Standard
state preemption
consulting physician
breach of confidential communication
20. 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.
complience plan
Treating or performing physician
Privacy officer
fraud
21. The condition of being secluded from the presence or view of others.
self-referral
Claim
privacy
confidentiality
22. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Treating or performing physician
Network
abuse
(DME) Durable Medical Equipment
23. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
health care provider
cash flow
deductible
(UCR) Usual - Customary and Reasonable
24. 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
complience
(ERISA) Employee Retirement Income Security Act of 1974
ppo
25. 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 entity
(OOPs) Out of Pocket Costs/Expenses
Supplementary Medical Insurance
Pre-certification
26. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
(ERISA) Employee Retirement Income Security Act of 1974
(UR) Utilization review
Beneficiary
27. Integrating benefits payable under more than one health insurance.
hmo
Coordinated Coverage
breach of confidential communication
Pre-existing Condition Exclusion
28. A willful act by an employee of taking possession of an employer's money
Privileged information
Amblatory Care
Embezzlement
(UR) Utilization review
29. 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
Supplementary Medical Insurance
open panel HMO
nonprivileged information
transaction
30. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Out of Network (OON)
Medigap Insurance
ethics
31. 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
(POS) Point-of Service Plan
Assignment & Authorization
Notice of Privacy Practices
Pre-existing Condition Exclusion
32. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
Treating or performing physician
crossover claim
(Non-par) Non-Participating Provider
33. 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
complience plan
Supplementary Medical Insurance
business associate
(Non-par) Non-Participating Provider
34. 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
Network
(UR) Utilization review
Security Rule
Out of Network (OON)
35. 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
Preauthorization
(PCN) Primary Care Network
disclosure
(EPO) Exclusive Provider Organization
36. 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.
hmo
(PCN) Primary Care Network
Privileged information
fraud
37. The period of time that payment for Medicare inpatient hospital benefits are available
referral
(ABN) Advance Beneficiary Notice
benefit period
ppo
38. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
Protected health information
benefit period
(AOB) Assignment of Benefits
cash flow
39. Customs - rules of conduct - courtesy - and manners of the medical profession
Standard
Experimental Procedures
(ABN) Advance Beneficiary Notice
etiquette
40. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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41. What the insurance company will consider paying for as defined in the contract.
(TPA) Third Party Administrator
privacy
hmo
Covered Expenses
42. 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
Covered Expenses
open panel HMO
(EPO) Exclusive Provider Organization
Pre-existing Condition Exclusion
43. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
ppo
crossover claim
(OOPs) Out of Pocket Costs/Expenses
open panel HMO
44. A monthly fee paid by the insured for specific medical insurance coverage
cash flow
e-health information management
Resonable Charge
premium
45. Health Information Portability and Accountability Act
Participating Provider
Confidential communication
HIPAA
business associate
46. 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.
(COBRA)
(POS) Point-of Service Plan
ordering physician
security officer
47. Integrating benefits payable under more than one health insurance.
(APC) Ambulatory Patient Classifications
Coordinated Coverage
Assignment & Authorization
subscriber
48. A privileged communication that may be disclosed only with the patient's permission.
privacy
(UR) Utilization review
Confidential communication
breach of confidential communication
49. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(TPA) Third Party Administrator
disclosure
authorization form
Claim
50. Verbal or written agreement that gives approval to some action - situation - or statement.
Protected health information
open panel HMO
consent
Individually identifiable health information