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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. Health Information Portability and Accountability Act
covered entity
HIPAA
Out of Network (OON)
Specialist
2. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Specialist
security officer
Subscriber
epo
3. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
attending physician
crossover claim
Protected health information
4. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Treating or performing physician
Pre-existing Condition Exclusion
Privacy officer
referral
5. A clinic that is owned by the HMO and the physicians are employees of the HMO
Deductible
(PPS) Hospital Impatient Prospective Payment System
closed panel HMO
ee schedule
6. A structure for classifying outpatient services and procedures for purpose of payment
crossover claim
(APC) Ambulatory Patient Classifications
Subscriber
pos
7. 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
ethics
transaction
(ERISA) Employee Retirement Income Security Act of 1974
8. 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
e-health information management
Standard
medical foundation
Assignment & Authorization
9. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Referral
e-health information management
abuse
HIPAA
10. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Privacy officer
claim
complience
Consent form
11. Medical services provided on an outpatient basis
confidentiality
Amblatory Care
(DME) Durable Medical Equipment
preauthorization
12. Someone who is eligible for or receiving benefits under an insurance policy or plan
(ABN) Advance Beneficiary Notice
preauthorization
Preauthorization
Beneficiary
13. A rule - condition - or requirement
Covered Expenses
(Non-par) Non-Participating Provider
abuse
Standard
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
complience
hmo
Assignment & Authorization
Pre-certification
15. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
subscriber
Pre-certification
medical foundation
16. An intentional misrepresentation of the facts to deceive or mislead another.
subscriber
Allowed Expenses
closed panel HMO
fraud
17. A monthly fee paid by the insured for specific medical insurance coverage
premium
epo
breach of confidential communication
abuse
18. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Protected health information
Amblatory Care
closed panel HMO
complience
19. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(DOS) Date of Service
Claim
self-referral
referring physician
20. A list of the amount to be paid by an insurance company for each procedure service
complience plan
authorization form
Resonable Charge
ee schedule
21. What the insurance company will consider paying for as defined in the contract.
(UR) Utilization review
Covered Expenses
cash flow
ppo
22. 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
(COB) Coordination of Benefits
(DME) Durable Medical Equipment
authorization form
23. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Participating Provider
Preauthorization
clearinghouse
(UCR) Usual - Customary and Reasonable
24. 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.
Resonable Charge
pos
Notice of Privacy Practices
Experimental Procedures
25. A provision that apples when a person is covered under more than one group medical program
Supplementary Medical Insurance
Coordinated Coverage
Beneficiary
(COB) Coordination of Benefits
26. Verbal or written agreement that gives approval to some action - situation - or statement.
(PAC) Pre- Admission Certification
consent
Amblatory Care
electronic media
27. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
claim
hmo
electronic media
Medigap Insurance
28. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Privacy officer
disclosure
Amblatory Care
(TPA) Third Party Administrator
29. 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
consulting physician
AMA
(ABN) Advance Beneficiary Notice
30. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
clearinghouse
Specialist
Assignment & Authorization
Covered Expenses
31. Customs - rules of conduct - courtesy - and manners of the medical profession
(PCN) Primary Care Network
etiquette
Open Enrollment
(Non-par) Non-Participating Provider
32. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Coordinated Coverage
Deductible
(PCP) Primary Care Physician
(UR) Utilization review
33. A health insurance enrollee chooses to see an out of network provider without authorization
(DCI) Duplicate Coverage Inquiry
(ABN) Advance Beneficiary Notice
Security Rule
self-referral
34. A review of the need for inpatient hospital care - completed before the actual admission
premium
referring physician
Referral
(PAC) Pre- Admission Certification
35. 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
breach of confidential communication
(ABN) Advance Beneficiary Notice
privacy
(PCN) Primary Care Network
36. A health insurance enrollee chooses to see an out of network provider without authorization
preauthorization
(DME) Durable Medical Equipment
self-referral
Referral
37. Unauthorized release of information
authorization form
breach of confidential communication
Referral
Privacy officer
38. 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)
e-health information management
(AOB) Assignment of Benefits
Consent form
(DOS) Date of Service
39. 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.
Deductible
Privacy officer
abuse
referring physician
40. 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
premium
epo
(AOB) Assignment of Benefits
nonprivileged information
41. 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.
preauthorization
Notice of Privacy Practices
Referral
(DME) Durable Medical Equipment
42. 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
Covered Expenses
IIHI
IIHI
epo
43. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(TPA) Third Party Administrator
referring physician
cash flow
44. 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
complience
transaction
confidentiality
Maximum Out Of Pocket
45. 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
referral
covered entity
(PAC) Pre- Admission Certification
health care provider
46. 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.
ppo
Notice of Privacy Practices
business associate
Resonable Charge
47. Medical services provided on an outpatient basis
ordering physician
Amblatory Care
Covered Expenses
ee schedule
48. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
covered entity
hmo
self-referral
49. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(ABN) Advance Beneficiary Notice
(PAC) Pre- Admission Certification
complience plan
breach of confidential communication
50. 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
Network
covered entity
Participating Provider
health care provider