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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.
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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. 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.
phantom billing
state preemption
Allowed Expenses
Notice of Privacy Practices
2. 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
Claim
Medigap Insurance
complience
Preauthorization
3. 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
subscriber
covered entity
ordering physician
4. 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
(DME) Durable Medical Equipment
prepaid plan
Deductible
health care provider
5. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
clearinghouse
electronic media
(TPA) Third Party Administrator
Medigap Insurance
6. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Amblatory Care
IIHI
crossover claim
pcp
7. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
closed panel HMO
(ABN) Advance Beneficiary Notice
pos
econdary Payer
8. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
(OOPs) Out of Pocket Costs/Expenses
pos
Pre-certification
disclosure
9. A review of the need for inpatient hospital care - completed before the actual admission
(ABN) Advance Beneficiary Notice
(DOS) Date of Service
(PAC) Pre- Admission Certification
ordering physician
10. 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
Preauthorization
crossover claim
Coordinated Coverage
11. 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
open panel HMO
Pre-existing Condition Exclusion
referral
benefit period
12. A nonprofit integrated delivery system
medical foundation
cash flow
Medigap Insurance
pcp
13. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
etiquette
(DOS) Date of Service
(DME) Durable Medical Equipment
14. 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.
Claim
Notice of Privacy Practices
self-referral
Pre-certification
15. The maximum amount a plan pays for a covered service
Experimental Procedures
ids
self-referral
Allowed Expenses
16. Medical services provided on an outpatient basis
Consent form
(AOB) Assignment of Benefits
Amblatory Care
(COBRA)
17. Unauthorized release of information
security officer
Embezzlement
ee schedule
breach of confidential communication
18. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
e-health information management
claim
complience plan
(AOB) Assignment of Benefits
19. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
e-health information management
Claim
consulting physician
(PEC) Pre-existing condition
20. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(POS) Point-of Service Plan
Protected health information
(PCP) Primary Care Physician
21. 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
(DCI) Duplicate Coverage Inquiry
state preemption
(EPO) Exclusive Provider Organization
22. 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
Deductible
(DOS) Date of Service
(AOB) Assignment of Benefits
23. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
ethics
Notice of Privacy Practices
clearinghouse
consent
24. 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
(AOB) Assignment of Benefits
epo
authorization form
(DOS) Date of Service
25. American Medical Association
AMA
Security Rule
Maximum Out Of Pocket
(OOPs) Out of Pocket Costs/Expenses
26. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
econdary Payer
ee schedule
(DCI) Duplicate Coverage Inquiry
(DRG's)
27. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(Non-par) Non-Participating Provider
(TPA) Third Party Administrator
Maximum Out Of Pocket
consent
28. Unauthorized release of information
(APC) Ambulatory Patient Classifications
(COB) Coordination of Benefits
breach of confidential communication
confidentiality
29. 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.
etiquette
(COB) Coordination of Benefits
health care provider
Assignment & Authorization
30. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
subscriber
authorization form
Individually identifiable health information
closed panel HMO
31. A monthly fee paid by the insured for specific medical insurance coverage
nonprivileged information
pos
premium
AMA
32. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(DME) Durable Medical Equipment
Specialist
Consent form
prepaid plan
33. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
ppo
Coordinated Coverage
Maximum Out Of Pocket
Open Enrollment
34. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
e-health information management
Beneficiary
Network
hmo
35. 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
nonprivileged information
consulting physician
deductible
(Non-par) Non-Participating Provider
36. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
(Non-par) Non-Participating Provider
AMA
econdary Payer
37. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
hmo
transaction
complience
subscriber
38. 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
Maximum Out Of Pocket
(AOB) Assignment of Benefits
business associate
39. 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.
security officer
Deductible
Pre-existing Condition Exclusion
(PPS) Hospital Impatient Prospective Payment System
40. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Subscriber
(OOPs) Out of Pocket Costs/Expenses
epo
referral
41. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
prepaid plan
transaction
breach of confidential communication
42. 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
AMA
(PCP) Primary Care Physician
(DCI) Duplicate Coverage Inquiry
(COBRA)
43. 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
electronic media
Supplementary Medical Insurance
Open Enrollment
(ABN) Advance Beneficiary Notice
44. 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
cash flow
econdary Payer
Treating or performing physician
45. A provision that apples when a person is covered under more than one group medical program
self-referral
(COB) Coordination of Benefits
complience plan
Beneficiary
46. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
(PCN) Primary Care Network
state preemption
Subscriber
47. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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48. 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.
subscriber
Standard
Protected health information
(TPA) Third Party Administrator
49. A privileged communication that may be disclosed only with the patient's permission.
Individually identifiable health information
Privacy officer
Confidential communication
(PEC) Pre-existing condition
50. 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
preauthorization
Sub-acute Care
Subscriber
(ABN) Advance Beneficiary Notice