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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. 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
clearinghouse
ppo
epo
nonprivileged information
2. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
referral
Supplementary Medical Insurance
(UCR) Usual - Customary and Reasonable
Embezzlement
3. Unauthorized release of information
breach of confidential communication
AMA
cash flow
(POS) Point-of Service Plan
4. 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.
(OOPs) Out of Pocket Costs/Expenses
hmo
(PPS) Hospital Impatient Prospective Payment System
security officer
5. 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.
security officer
complience
Claim
Referral
6. A structure for classifying outpatient services and procedures for purpose of payment
Maximum Out Of Pocket
(APC) Ambulatory Patient Classifications
(TPA) Third Party Administrator
Coordinated Coverage
7. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
ids
Medigap Insurance
Participating Provider
8. A willful act by an employee of taking possession of an employer's money
complience
(PAC) Pre- Admission Certification
Embezzlement
ee schedule
9. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
IIHI
confidentiality
(UCR) Usual - Customary and Reasonable
nonprivileged information
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
authorization form
(UCR) Usual - Customary and Reasonable
ordering physician
Experimental Procedures
11. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Confidential communication
deductible
closed panel HMO
Claim
12. 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.
claim
(DCI) Duplicate Coverage Inquiry
Notice of Privacy Practices
(ERISA) Employee Retirement Income Security Act of 1974
13. A health insurance enrollee chooses to see an out of network provider without authorization
Open Enrollment
self-referral
Embezzlement
AMA
14. American Medical Association
AMA
disclosure
electronic media
e-health information management
15. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Preauthorization
(AOB) Assignment of Benefits
ordering physician
Open Enrollment
16. 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
Consent form
authorization form
epo
confidentiality
17. 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
Notice of Privacy Practices
Consent form
Participating Provider
(COBRA)
18. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Medigap Insurance
(Non-par) Non-Participating Provider
business associate
19. 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
(COB) Coordination of Benefits
Supplementary Medical Insurance
Network
prepaid plan
20. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
pcp
crossover claim
Embezzlement
complience plan
21. 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
covered entity
phantom billing
self-referral
e-health information management
22. 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
Standard
closed panel HMO
pos
econdary Payer
23. 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
Security Rule
privacy
disclosure
Specialist
24. 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.
state preemption
Allowed Expenses
transaction
Preauthorization
25. Is the provider who renders a service to a patient
authorization form
Treating or performing physician
Allowed Expenses
benefit period
26. The condition of being secluded from the presence or view of others.
attending physician
privacy
Participating Provider
(AOB) Assignment of Benefits
27. A monthly fee paid by the insured for specific medical insurance coverage
premium
fraud
Referral
medical foundation
28. The condition of being secluded from the presence or view of others.
(AOB) Assignment of Benefits
Claim
Assignment & Authorization
privacy
29. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Supplementary Medical Insurance
referral
subscriber
Maximum Out Of Pocket
30. 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
referral
(PCP) Primary Care Physician
cash flow
Treating or performing physician
31. Integrating benefits payable under more than one health insurance.
clearinghouse
Privacy officer
Individually identifiable health information
Coordinated Coverage
32. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Consent form
phantom billing
(PEC) Pre-existing condition
33. 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
e-health information management
(UR) Utilization review
Assignment & Authorization
Notice of Privacy Practices
34. Integrating benefits payable under more than one health insurance.
ordering physician
Coordinated Coverage
business associate
Sub-acute Care
35. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Open Enrollment
business associate
Allowed Expenses
36. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(AOB) Assignment of Benefits
claim
prepaid plan
(POS) Point-of Service Plan
37. 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.
(COBRA)
Resonable Charge
Privacy officer
prepaid plan
38. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Security Rule
(UCR) Usual - Customary and Reasonable
Resonable Charge
ethics
39. Customs - rules of conduct - courtesy - and manners of the medical profession
health care provider
etiquette
ordering physician
attending physician
40. 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
(COBRA)
Maximum Out Of Pocket
(UR) Utilization review
ethics
41. 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
(Non-par) Non-Participating Provider
(PEC) Pre-existing condition
business associate
42. 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
Open Enrollment
health care provider
benefit period
business associate
43. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
Consent form
HIPAA
referring physician
44. A privileged communication that may be disclosed only with the patient's permission.
Medigap Insurance
Pre-existing Condition Exclusion
Pre-certification
Confidential communication
45. What the insurance company will consider paying for as defined in the contract.
Claim
Covered Expenses
preauthorization
security officer
46. Is a provider who sends the patients for testing or treatment
(COB) Coordination of Benefits
pos
(EPO) Exclusive Provider Organization
referring physician
47. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Coordinated Coverage
HIPAA
Individually identifiable health information
(COBRA)
48. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(APC) Ambulatory Patient Classifications
electronic media
claim
pos
49. Verbal or written agreement that gives approval to some action - situation - or statement.
covered entity
Maximum Out Of Pocket
consent
complience plan
50. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
breach of confidential communication
complience plan
(PAC) Pre- Admission Certification
phantom billing
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