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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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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. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
referring physician
Pre-existing Condition Exclusion
abuse
Subscriber
2. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Allowed Expenses
hmo
Referral
3. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage
econdary Payer
(PCP) Primary Care Physician
complience
state preemption
4. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Pre-certification
Subscriber
AMA
consent
5. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Standard
Out of Network (OON)
Individually identifiable health information
Specialist
6. A privileged communication that may be disclosed only with the patient's permission.
Privacy officer
Treating or performing physician
Confidential communication
pcp
7. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
Coordinated Coverage
ordering physician
medical foundation
8. 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
Supplementary Medical Insurance
fraud
complience plan
(COBRA)
9. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
(COB) Coordination of Benefits
(DOS) Date of Service
epo
10. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
(PPS) Hospital Impatient Prospective Payment System
(Non-par) Non-Participating Provider
(ERISA) Employee Retirement Income Security Act of 1974
business associate
11. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
Privileged information
(DME) Durable Medical Equipment
breach of confidential communication
12. Medical services provided on an outpatient basis
(DRG's)
business associate
Amblatory Care
ppo
13. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Notice of Privacy Practices
Medigap Insurance
(DOS) Date of Service
Coordinated Coverage
14. Billing for services not performed
(UR) Utilization review
(ERISA) Employee Retirement Income Security Act of 1974
(Non-par) Non-Participating Provider
phantom billing
15. 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
(POS) Point-of Service Plan
(AOB) Assignment of Benefits
(PEC) Pre-existing condition
(APC) Ambulatory Patient Classifications
16. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Consent form
Sub-acute Care
epo
17. 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
Notice of Privacy Practices
Deductible
ppo
Embezzlement
18. 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
prepaid plan
preauthorization
authorization form
Individually identifiable health information
19. 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
Protected health information
epo
(OOPs) Out of Pocket Costs/Expenses
self-referral
20. 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
Resonable Charge
(PCN) Primary Care Network
Claim
complience
21. 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.
Covered Expenses
AMA
Protected health information
ee schedule
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
electronic media
attending physician
(PCN) Primary Care Network
(APC) Ambulatory Patient Classifications
23. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
AMA
econdary Payer
hmo
24. 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
Assignment & Authorization
complience plan
claim
Amblatory Care
25. What the insurance company will consider paying for as defined in the contract.
epo
Covered Expenses
nonprivileged information
disclosure
26. 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.
epo
Notice of Privacy Practices
Experimental Procedures
(OOPs) Out of Pocket Costs/Expenses
27. 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.
benefit period
complience plan
e-health information management
Privileged information
28. A patient claim is eligible for medicare and medicaid
Assignment & Authorization
phantom billing
crossover claim
epo
29. 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
complience
Deductible
Out of Network (OON)
ethics
30. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
ordering physician
(PAC) Pre- Admission Certification
consent
31. 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
Pre-existing Condition Exclusion
cash flow
Specialist
epo
32. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Maximum Out Of Pocket
(PEC) Pre-existing condition
(APC) Ambulatory Patient Classifications
confidentiality
33. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage
Maximum Out Of Pocket
(PCP) Primary Care Physician
premium
Privacy officer
34. The amount of actual money available to the medical practice
cash flow
benefit period
preauthorization
Consent form
35. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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36. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
closed panel HMO
Claim
consulting physician
(PCP) Primary Care Physician
37. 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
Embezzlement
Out of Network (OON)
preauthorization
38. 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
prepaid plan
(POS) Point-of Service Plan
Allowed Expenses
open panel HMO
39. Standards of conduct generally accepted as a moral guide for behavior.
ethics
medical foundation
econdary Payer
(EPO) Exclusive Provider Organization
40. 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.
Subscriber
state preemption
clearinghouse
Protected health 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.
benefit period
(DRG's)
Beneficiary
Notice of Privacy Practices
42. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
(UR) Utilization review
(POS) Point-of Service Plan
authorization form
(ERISA) Employee Retirement Income Security Act of 1974
43. 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
AMA
(PCN) Primary Care Network
Pre-certification
Maximum Out Of Pocket
44. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
electronic media
Claim
e-health information management
econdary Payer
45. 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
(UCR) Usual - Customary and Reasonable
AMA
etiquette
Assignment & Authorization
46. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Consent form
state preemption
deductible
Supplementary Medical Insurance
47. 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
(OOPs) Out of Pocket Costs/Expenses
Sub-acute Care
ethics
Security Rule
48. 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
(ERISA) Employee Retirement Income Security Act of 1974
security officer
ppo
Supplementary Medical Insurance
49. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Open Enrollment
Resonable Charge
privacy
50. 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.
open panel HMO
security officer
Pre-existing Condition Exclusion
hmo