SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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. A health insurance enrollee chooses to see an out of network provider without authorization
attending physician
self-referral
clearinghouse
complience
2. Verbal or written agreement that gives approval to some action - situation - or statement.
referral
consent
phantom billing
Pre-existing Condition Exclusion
3. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
(COB) Coordination of Benefits
Consent form
(AOB) Assignment of Benefits
4. The maximum amount a plan pays for a covered service
Allowed Expenses
(COB) Coordination of Benefits
consulting physician
authorization form
5. An intentional misrepresentation of the facts to deceive or mislead another.
Specialist
fraud
Supplementary Medical Insurance
prepaid plan
6. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
hmo
ordering physician
Specialist
HIPAA
7. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
covered entity
confidentiality
open panel HMO
IIHI
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
Deductible
econdary Payer
ppo
health care provider
9. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
confidentiality
(ERISA) Employee Retirement Income Security Act of 1974
(EPO) Exclusive Provider Organization
(OOPs) Out of Pocket Costs/Expenses
10. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
Embezzlement
Experimental Procedures
Medigap Insurance
attending physician
11. What the insurance company will consider paying for as defined in the contract.
epo
Medigap Insurance
Covered Expenses
electronic media
12. Verbal or written agreement that gives approval to some action - situation - or statement.
Allowed Expenses
privacy
consent
epo
13. A review of the need for inpatient hospital care - completed before the actual admission
Preauthorization
Beneficiary
claim
(PAC) Pre- Admission Certification
14. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
Consent form
Privacy officer
abuse
15. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(UCR) Usual - Customary and Reasonable
Consent form
(AOB) Assignment of Benefits
(TPA) Third Party Administrator
16. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
epo
attending physician
(DCI) Duplicate Coverage Inquiry
Open Enrollment
17. Is the provider who renders a service to a patient
Treating or performing physician
pcp
Medigap Insurance
Privacy officer
18. 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
Standard
(DME) Durable Medical Equipment
Specialist
epo
19. 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
Network
benefit period
(PCP) Primary Care Physician
(Non-par) Non-Participating Provider
20. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
breach of confidential communication
Individually identifiable health information
ordering physician
(APC) Ambulatory Patient Classifications
21. 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
covered entity
Maximum Out Of Pocket
(PPS) Hospital Impatient Prospective Payment System
22. 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.
Assignment & Authorization
confidentiality
health care provider
Treating or performing physician
23. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Standard
pos
closed panel HMO
24. 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.
Subscriber
Privacy officer
(OOPs) Out of Pocket Costs/Expenses
Subscriber
25. A clinic that is owned by the HMO and the physicians are employees of the HMO
Subscriber
closed panel HMO
transaction
(COB) Coordination of Benefits
26. 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
Covered Expenses
econdary Payer
ethics
open panel HMO
27. The condition of being secluded from the presence or view of others.
deductible
(POS) Point-of Service Plan
cash flow
privacy
28. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Subscriber
Medigap Insurance
(OOPs) Out of Pocket Costs/Expenses
29. 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
epo
Open Enrollment
(ABN) Advance Beneficiary Notice
etiquette
30. 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
Maximum Out Of Pocket
Beneficiary
(DME) Durable Medical Equipment
Claim
31. 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
(ERISA) Employee Retirement Income Security Act of 1974
Allowed Expenses
Referral
ordering physician
32. 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
Privileged information
pos
nonprivileged information
33. Integrating benefits payable under more than one health insurance.
Pre-certification
epo
Subscriber
Coordinated Coverage
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
pos
Out of Network (OON)
(COB) Coordination of Benefits
(DME) Durable Medical Equipment
35. 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.
HIPAA
breach of confidential communication
AMA
Privileged information
36. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Consent form
(OOPs) Out of Pocket Costs/Expenses
Allowed Expenses
ee schedule
37. 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
Pre-existing Condition Exclusion
(PCP) Primary Care Physician
prepaid plan
(ABN) Advance Beneficiary Notice
38. An intentional misrepresentation of the facts to deceive or mislead another.
(POS) Point-of Service Plan
ethics
attending physician
fraud
39. A privileged communication that may be disclosed only with the patient's permission.
closed panel HMO
ids
complience plan
Confidential communication
40. 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
(PCP) Primary Care Physician
Pre-certification
(COB) Coordination of Benefits
authorization form
41. 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
complience
Coordinated Coverage
Privileged information
42. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
(PCN) Primary Care Network
(PPS) Hospital Impatient Prospective Payment System
(COBRA)
43. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Claim
Pre-existing Condition Exclusion
Pre-certification
Coordinated Coverage
44. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Confidential communication
(TPA) Third Party Administrator
Amblatory Care
45. Billing for services not performed
(DCI) Duplicate Coverage Inquiry
premium
Standard
phantom billing
46. The amount of actual money available to the medical practice
etiquette
Covered Expenses
(ERISA) Employee Retirement Income Security Act of 1974
cash flow
47. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
business associate
Deductible
complience plan
Out of Network (OON)
48. 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
Security Rule
(DCI) Duplicate Coverage Inquiry
Medigap Insurance
Maximum Out Of Pocket
49. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(UR) Utilization review
(PAC) Pre- Admission Certification
(PEC) Pre-existing condition
transaction
50. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
ordering physician
(COB) Coordination of Benefits
Individually identifiable health information
ppo