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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. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Consent form
subscriber
(PCN) Primary Care Network
Pre-existing Condition Exclusion
2. 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
Pre-existing Condition Exclusion
subscriber
(PCP) Primary Care Physician
business associate
3. 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
ordering physician
benefit period
complience
Out of Network (OON)
4. Health Information Portability and Accountability Act
premium
subscriber
HIPAA
Deductible
5. Someone who is eligible for or receiving benefits under an insurance policy or plan
ppo
Beneficiary
etiquette
electronic media
6. 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.
(PCP) Primary Care Physician
electronic media
Resonable Charge
Privileged information
7. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Pre-certification
ee schedule
Beneficiary
Resonable Charge
8. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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9. 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
subscriber
Experimental Procedures
Consent form
Maximum Out Of Pocket
10. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
ordering physician
IIHI
(PAC) Pre- Admission Certification
11. American Medical Association
attending physician
AMA
e-health information management
deductible
12. 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.
subscriber
complience plan
health care provider
transaction
13. What the insurance company will consider paying for as defined in the contract.
(APC) Ambulatory Patient Classifications
Covered Expenses
(TPA) Third Party Administrator
ee schedule
14. 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
Experimental Procedures
(POS) Point-of Service Plan
Coordinated Coverage
preauthorization
15. A review of the need for inpatient hospital care - completed before the actual admission
(DOS) Date of Service
(PAC) Pre- Admission Certification
Experimental Procedures
ethics
16. 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
Sub-acute Care
ordering physician
Embezzlement
state preemption
17. 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
claim
Individually identifiable health information
Coordinated Coverage
Assignment & Authorization
18. A rule - condition - or requirement
transaction
Standard
Protected health information
attending physician
19. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
premium
abuse
(DCI) Duplicate Coverage Inquiry
(COBRA)
20. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Confidential communication
Subscriber
prepaid plan
Open Enrollment
21. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(EPO) Exclusive Provider Organization
open panel HMO
consent
22. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
preauthorization
Network
consent
Embezzlement
23. 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
authorization form
(ABN) Advance Beneficiary Notice
pos
(OOPs) Out of Pocket Costs/Expenses
24. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
AMA
clearinghouse
(COB) Coordination of Benefits
Out of Network (OON)
25. 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)
Privileged information
Consent form
ee schedule
(PCN) Primary Care Network
26. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
security officer
etiquette
Pre-certification
claim
27. 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
ethics
epo
Supplementary Medical Insurance
deductible
28. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
fraud
(OOPs) Out of Pocket Costs/Expenses
abuse
consent
29. A structure for classifying outpatient services and procedures for purpose of payment
Security Rule
consent
(APC) Ambulatory Patient Classifications
HIPAA
30. 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
(ABN) Advance Beneficiary Notice
pcp
self-referral
pos
31. 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.
covered entity
ee schedule
phantom billing
security officer
32. 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
Maximum Out Of Pocket
Treating or performing physician
open panel HMO
(EPO) Exclusive Provider Organization
33. 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
Embezzlement
(PAC) Pre- Admission Certification
pos
premium
34. 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
crossover claim
Deductible
hmo
Open Enrollment
35. 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
(PAC) Pre- Admission Certification
(COB) Coordination of Benefits
claim
ppo
36. A monthly fee paid by the insured for specific medical insurance coverage
ids
closed panel HMO
premium
crossover claim
37. 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
breach of confidential communication
pcp
self-referral
38. The period of time that payment for Medicare inpatient hospital benefits are available
pos
fraud
medical foundation
benefit period
39. 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.
Out of Network (OON)
Consent form
business associate
AMA
40. 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
closed panel HMO
(TPA) Third Party Administrator
covered entity
epo
41. 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
breach of confidential communication
(COBRA)
(Non-par) Non-Participating Provider
Individually identifiable health information
42. 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
authorization form
e-health information management
(PCN) Primary Care Network
ordering physician
43. Customs - rules of conduct - courtesy - and manners of the medical profession
(DRG's)
subscriber
pos
etiquette
44. 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
clearinghouse
closed panel HMO
open panel HMO
complience plan
45. 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
Standard
Supplementary Medical Insurance
Confidential communication
closed panel HMO
46. The condition of being secluded from the presence or view of others.
self-referral
Experimental Procedures
ids
privacy
47. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
covered entity
prepaid plan
complience plan
HIPAA
48. The condition of being secluded from the presence or view of others.
privacy
electronic media
Notice of Privacy Practices
Privacy officer
49. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
Consent form
Assignment & Authorization
(PEC) Pre-existing condition
50. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
benefit period
consulting physician
Assignment & Authorization
claim