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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. Medicare's method of paying acute care hospitals for inpatient care
Treating or performing physician
(PPS) Hospital Impatient Prospective Payment System
subscriber
Open Enrollment
2. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
HIPAA
Experimental Procedures
attending physician
Claim
3. 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
benefit period
Pre-certification
Medigap Insurance
(Non-par) Non-Participating Provider
4. An intentional misrepresentation of the facts to deceive or mislead another.
Subscriber
benefit period
abuse
fraud
5. 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
Deductible
claim
Treating or performing physician
AMA
6. 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.
complience
security officer
Sub-acute Care
Individually identifiable health information
7. 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.
Privacy officer
electronic media
Network
ee schedule
8. 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
Security Rule
econdary Payer
business associate
(PCP) Primary Care Physician
9. 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)
breach of confidential communication
(POS) Point-of Service Plan
Consent form
referral
10. 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
consent
AMA
medical foundation
epo
11. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
abuse
deductible
Resonable Charge
12. 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
Network
Sub-acute Care
(COBRA)
(EPO) Exclusive Provider Organization
13. Health Information Portability and Accountability Act
closed panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
Notice of Privacy Practices
HIPAA
14. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(EPO) Exclusive Provider Organization
Consent form
Pre-certification
(PEC) Pre-existing condition
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.
health care provider
complience
Preauthorization
electronic media
16. 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.
closed panel HMO
breach of confidential communication
state preemption
(APC) Ambulatory Patient Classifications
17. 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
(PPS) Hospital Impatient Prospective Payment System
Standard
(UR) Utilization review
(AOB) Assignment of Benefits
18. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Referral
(DCI) Duplicate Coverage Inquiry
Coordinated Coverage
state preemption
19. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Network
e-health information management
(PPS) Hospital Impatient Prospective Payment System
(PCP) Primary Care Physician
20. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Consent form
crossover claim
consent
complience
21. The maximum amount a plan pays for a covered service
Allowed Expenses
(AOB) Assignment of Benefits
Security Rule
Coordinated Coverage
22. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
state preemption
consent
Privileged information
23. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Covered Expenses
Resonable Charge
Specialist
electronic media
24. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
self-referral
Standard
open panel HMO
25. Integrating benefits payable under more than one health insurance.
Pre-existing Condition Exclusion
referral
(ERISA) Employee Retirement Income Security Act of 1974
Coordinated Coverage
26. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
cash flow
premium
disclosure
covered entity
27. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
medical foundation
Assignment & Authorization
subscriber
preauthorization
28. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
cash flow
referral
prepaid plan
29. 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
ids
fraud
open panel HMO
ppo
30. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Assignment & Authorization
benefit period
electronic media
31. Someone who is eligible for or receiving benefits under an insurance policy or plan
Participating Provider
abuse
Beneficiary
health care provider
32. 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
deductible
phantom billing
Maximum Out Of Pocket
(Non-par) Non-Participating Provider
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
Notice of Privacy Practices
benefit period
(PCP) Primary Care Physician
electronic media
34. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
ppo
Open Enrollment
e-health information management
Standard
35. What the insurance company will consider paying for as defined in the contract.
(AOB) Assignment of Benefits
Covered Expenses
etiquette
Specialist
36. 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.
etiquette
(AOB) Assignment of Benefits
state preemption
Maximum Out Of Pocket
37. 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
security officer
AMA
ethics
Pre-existing Condition Exclusion
38. A rule - condition - or requirement
Standard
HIPAA
Notice of Privacy Practices
security officer
39. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
complience plan
state preemption
Privacy officer
(UCR) Usual - Customary and Reasonable
40. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Amblatory Care
complience
Protected health information
hmo
41. Medicare's method of paying acute care hospitals for inpatient care
referring physician
abuse
nonprivileged information
(PPS) Hospital Impatient Prospective Payment System
42. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Standard
benefit period
Beneficiary
preauthorization
43. 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
Experimental Procedures
(PCN) Primary Care Network
preauthorization
subscriber
44. A health insurance enrollee chooses to see an out of network provider without authorization
pcp
(PEC) Pre-existing condition
(APC) Ambulatory Patient Classifications
self-referral
45. 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
pos
Out of Network (OON)
breach of confidential communication
Participating Provider
46. A privileged communication that may be disclosed only with the patient's permission.
Notice of Privacy Practices
Specialist
covered entity
Confidential communication
47. Unauthorized release of information
breach of confidential communication
Pre-certification
consent
(COB) Coordination of Benefits
48. 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
open panel HMO
Covered Expenses
Consent form
pos
49. A patient claim is eligible for medicare and medicaid
(POS) Point-of Service Plan
epo
pos
crossover claim
50. A monthly fee paid by the insured for specific medical insurance coverage
security officer
premium
covered entity
deductible