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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists
security officer
ethics
Preauthorization
Referral
2. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method
security officer
e-health information management
epo
prepaid plan
3. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PAC) Pre- Admission Certification
(PEC) Pre-existing condition
Pre-existing Condition Exclusion
Protected health information
4. An intentional misrepresentation of the facts to deceive or mislead another.
(TPA) Third Party Administrator
fraud
pos
Specialist
5. A provision that apples when a person is covered under more than one group medical program
consent
state preemption
(COB) Coordination of Benefits
epo
6. Someone who is eligible for or receiving benefits under an insurance policy or plan
deductible
Claim
Beneficiary
(OOPs) Out of Pocket Costs/Expenses
7. 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
IIHI
Maximum Out Of Pocket
complience
nonprivileged information
8. American Medical Association
covered entity
privacy
AMA
benefit period
9. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(AOB) Assignment of Benefits
(OOPs) Out of Pocket Costs/Expenses
ee schedule
Pre-certification
10. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(COB) Coordination of Benefits
Amblatory Care
(TPA) Third Party Administrator
transaction
11. A privileged communication that may be disclosed only with the patient's permission.
(EPO) Exclusive Provider Organization
closed panel HMO
ee schedule
Confidential communication
12. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
transaction
(TPA) Third Party Administrator
Notice of Privacy Practices
13. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Assignment & Authorization
complience
attending physician
Privacy officer
14. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
closed panel HMO
hmo
(DRG's)
econdary Payer
15. 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.
(AOB) Assignment of Benefits
phantom billing
ee schedule
health care provider
16. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Privileged information
deductible
Medigap Insurance
17. 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
IIHI
cash flow
consent
18. 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.
hmo
covered entity
Privileged information
business associate
19. Is a provider who sends the patients for testing or treatment
referring physician
(PCP) Primary Care Physician
open panel HMO
HIPAA
20. 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
Protected health information
Referral
pos
(PCP) Primary Care Physician
21. An intentional misrepresentation of the facts to deceive or mislead another.
claim
electronic media
(DOS) Date of Service
fraud
22. 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
(COBRA)
consent
econdary Payer
econdary Payer
23. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
prepaid plan
(COBRA)
health care provider
Pre-certification
24. 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
Assignment & Authorization
Privileged information
consulting physician
Sub-acute Care
25. 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
fraud
Notice of Privacy Practices
Out of Network (OON)
open panel HMO
26. Medical services provided on an outpatient basis
Pre-certification
Pre-existing Condition Exclusion
cash flow
Amblatory Care
27. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
phantom billing
hmo
privacy
28. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
prepaid plan
Privacy officer
Protected health information
29. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
open panel HMO
HIPAA
medical foundation
30. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Supplementary Medical Insurance
ordering physician
pcp
Network
31. An organization of provider sites with a contracted relationship that offer services
(PCN) Primary Care Network
Treating or performing physician
ids
Treating or performing physician
32. 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
closed panel HMO
AMA
(DME) Durable Medical Equipment
nonprivileged information
33. Individually identifiable health information
Embezzlement
IIHI
nonprivileged information
(APC) Ambulatory Patient Classifications
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
subscriber
Privileged information
hmo
Out of Network (OON)
35. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Consent form
(OOPs) Out of Pocket Costs/Expenses
Pre-existing Condition Exclusion
nonprivileged information
36. A rule - condition - or requirement
(UR) Utilization review
Standard
(PCN) Primary Care Network
clearinghouse
37. 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.
Standard
abuse
Privacy officer
Resonable Charge
38. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
crossover claim
closed panel HMO
(UR) Utilization review
e-health information management
39. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
authorization form
complience plan
Privileged information
40. 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
consulting physician
premium
(Non-par) Non-Participating Provider
Assignment & Authorization
41. 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
Covered Expenses
Maximum Out Of Pocket
consent
Specialist
42. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(AOB) Assignment of Benefits
Referral
(PEC) Pre-existing condition
covered entity
43. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
open panel HMO
e-health information management
consulting physician
Beneficiary
44. 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
(APC) Ambulatory Patient Classifications
(DME) Durable Medical Equipment
Claim
45. Billing for services not performed
econdary Payer
nonprivileged information
phantom billing
transaction
46. A structure for classifying outpatient services and procedures for purpose of payment
epo
Out of Network (OON)
(APC) Ambulatory Patient Classifications
subscriber
47. 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.
(AOB) Assignment of Benefits
(PCN) Primary Care Network
health care provider
Protected health information
48. 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
(UCR) Usual - Customary and Reasonable
(DME) Durable Medical Equipment
Network
49. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
abuse
(DME) Durable Medical Equipment
(UR) Utilization review
preauthorization
50. Billing for services not performed
Experimental Procedures
benefit period
phantom billing
IIHI