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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. Medical staff member who is legally responsible for the care and treatment given to a patient.
referral
(COBRA)
attending physician
Notice of Privacy Practices
2. 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
Protected health information
Open Enrollment
preauthorization
Maximum Out Of Pocket
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
disclosure
(OOPs) Out of Pocket Costs/Expenses
authorization form
self-referral
4. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
ids
ethics
econdary Payer
Protected health information
5. The condition of being secluded from the presence or view of others.
privacy
preauthorization
fraud
Individually identifiable health information
6. A monthly fee paid by the insured for specific medical insurance coverage
abuse
Privacy officer
premium
closed panel HMO
7. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(EPO) Exclusive Provider Organization
deductible
(DCI) Duplicate Coverage Inquiry
HIPAA
8. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
(ERISA) Employee Retirement Income Security Act of 1974
econdary Payer
ids
9. 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
HIPAA
(DCI) Duplicate Coverage Inquiry
(TPA) Third Party Administrator
10. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
Privacy officer
Medigap Insurance
Amblatory Care
Security Rule
11. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
breach of confidential communication
(Non-par) Non-Participating Provider
ee schedule
12. 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
IIHI
referring physician
crossover claim
13. 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
Participating Provider
(EPO) Exclusive Provider Organization
Covered Expenses
open panel HMO
14. 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
ee schedule
Covered Expenses
covered entity
prepaid plan
15. A privileged communication that may be disclosed only with the patient's permission.
ordering physician
Experimental Procedures
Confidential communication
hmo
16. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
ethics
covered entity
electronic media
Out of Network (OON)
17. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
preauthorization
Claim
Notice of Privacy Practices
ee schedule
18. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
complience
Pre-certification
nonprivileged information
(DRG's)
19. 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
(COBRA)
Specialist
pos
covered entity
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
health care provider
(UR) Utilization review
Participating Provider
(PCN) Primary Care Network
21. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Assignment & Authorization
etiquette
transaction
Referral
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
pcp
medical foundation
(PCN) Primary Care Network
(COBRA)
23. A structure for classifying outpatient services and procedures for purpose of payment
pos
Amblatory Care
(APC) Ambulatory Patient Classifications
Claim
24. 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
Deductible
attending physician
Privileged information
25. 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.
Protected health information
Deductible
(PPS) Hospital Impatient Prospective Payment System
Claim
26. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Open Enrollment
Medigap Insurance
health care provider
clearinghouse
27. A nonprofit integrated delivery system
Deductible
complience
(PPS) Hospital Impatient Prospective Payment System
medical foundation
28. Integrating benefits payable under more than one health insurance.
breach of confidential communication
(DME) Durable Medical Equipment
(OOPs) Out of Pocket Costs/Expenses
Coordinated Coverage
29. What the insurance company will consider paying for as defined in the contract.
covered entity
Preauthorization
Covered Expenses
Embezzlement
30. 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
clearinghouse
Privacy officer
(POS) Point-of Service Plan
Preauthorization
31. American Medical Association
AMA
ordering physician
econdary Payer
(PEC) Pre-existing condition
32. 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
Assignment & Authorization
complience
Subscriber
33. A rule - condition - or requirement
(PEC) Pre-existing condition
abuse
Standard
Pre-certification
34. 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
(COBRA)
(DME) Durable Medical Equipment
Beneficiary
Deductible
35. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
econdary Payer
breach of confidential communication
breach of confidential communication
36. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
covered entity
breach of confidential communication
prepaid plan
37. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(COBRA)
econdary Payer
(OOPs) Out of Pocket Costs/Expenses
subscriber
38. A clinic that is owned by the HMO and the physicians are employees of the HMO
(DOS) Date of Service
Referral
epo
closed panel HMO
39. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(DOS) Date of Service
confidentiality
(ABN) Advance Beneficiary Notice
business associate
40. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
claim
abuse
nonprivileged information
Subscriber
41. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
Notice of Privacy Practices
premium
Notice of Privacy Practices
42. Approval or consent by a primary physician for patient referral to ancillary services and specialists
abuse
(COB) Coordination of Benefits
Referral
breach of confidential communication
43. An intentional misrepresentation of the facts to deceive or mislead another.
attending physician
fraud
Standard
Standard
44. Billing for services not performed
clearinghouse
Security Rule
phantom billing
health care provider
45. Health Information Portability and Accountability Act
Pre-certification
HIPAA
(POS) Point-of Service Plan
ppo
46. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Deductible
(UR) Utilization review
confidentiality
Allowed Expenses
47. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
econdary Payer
e-health information management
complience
(COB) Coordination of Benefits
48. 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
HIPAA
(TPA) Third Party Administrator
Pre-existing Condition Exclusion
(PCP) Primary Care Physician
49. 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
clearinghouse
(COBRA)
(PCP) Primary Care Physician
ppo
50. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
epo
nonprivileged information
referral
Claim