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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. 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
open panel HMO
clearinghouse
phantom billing
2. 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
Participating Provider
preauthorization
(AOB) Assignment of Benefits
(UCR) Usual - Customary and Reasonable
3. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
nonprivileged information
ethics
complience plan
referral
4. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
claim
ids
Resonable Charge
business associate
5. Standards of conduct generally accepted as a moral guide for behavior.
Maximum Out Of Pocket
referral
security officer
ethics
6. 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
electronic media
open panel HMO
deductible
preauthorization
7. 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
attending physician
(COB) Coordination of Benefits
(Non-par) Non-Participating Provider
Privacy officer
8. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
ordering physician
Pre-existing Condition Exclusion
(DME) Durable Medical Equipment
9. Billing for services not performed
phantom billing
Pre-certification
hmo
(ERISA) Employee Retirement Income Security Act of 1974
10. Is a provider who sends the patients for testing or treatment
complience plan
claim
Protected health information
referring physician
11. The dates of healthcare services were provided to the beneficiary
premium
consent
(DOS) Date of Service
health care provider
12. 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
Consent form
Participating Provider
(UCR) Usual - Customary and Reasonable
ee schedule
13. 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
(PCN) Primary Care Network
health care provider
Sub-acute Care
electronic media
14. Individually identifiable health information
(DCI) Duplicate Coverage Inquiry
closed panel HMO
business associate
IIHI
15. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
(PEC) Pre-existing condition
HIPAA
Standard
16. 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
Assignment & Authorization
Network
deductible
ids
17. 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.
Privacy officer
(POS) Point-of Service Plan
business associate
nonprivileged information
18. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Pre-certification
Coordinated Coverage
preauthorization
Network
19. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Pre-existing Condition Exclusion
hmo
abuse
20. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(DOS) Date of Service
closed panel HMO
Medigap Insurance
Allowed Expenses
21. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Pre-certification
benefit period
consulting physician
22. 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.
AMA
Individually identifiable health information
Medigap Insurance
Notice of Privacy Practices
23. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
HIPAA
fraud
Resonable Charge
Network
24. 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
Security Rule
Beneficiary
authorization form
25. 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
ids
transaction
Experimental Procedures
26. 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
state preemption
Amblatory Care
(ABN) Advance Beneficiary Notice
27. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(ABN) Advance Beneficiary Notice
Participating Provider
Pre-existing Condition Exclusion
Referral
28. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PAC) Pre- Admission Certification
transaction
Preauthorization
complience
29. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Notice of Privacy Practices
ids
Specialist
30. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
clearinghouse
consulting physician
Coordinated Coverage
Amblatory Care
31. Customs - rules of conduct - courtesy - and manners of the medical profession
hmo
Supplementary Medical Insurance
Claim
etiquette
32. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Allowed Expenses
Referral
disclosure
ids
33. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Embezzlement
Treating or performing physician
(UCR) Usual - Customary and Reasonable
Pre-certification
34. 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
HIPAA
(ABN) Advance Beneficiary Notice
HIPAA
complience
35. 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
Out of Network (OON)
Individually identifiable health information
crossover claim
Amblatory Care
36. 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)
referring physician
Consent form
(OOPs) Out of Pocket Costs/Expenses
complience
37. 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
fraud
Experimental Procedures
HIPAA
38. 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
(COB) Coordination of Benefits
Resonable Charge
Treating or performing physician
39. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
abuse
econdary Payer
referral
subscriber
40. A privileged communication that may be disclosed only with the patient's permission.
self-referral
Confidential communication
Protected health information
security officer
41. Is the provider who renders a service to a patient
Individually identifiable health information
Treating or performing physician
deductible
Assignment & Authorization
42. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Preauthorization
(PEC) Pre-existing condition
Specialist
Assignment & Authorization
43. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
(DOS) Date of Service
Privacy officer
Participating Provider
44. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(Non-par) Non-Participating Provider
hmo
ppo
Covered Expenses
45. An organization of provider sites with a contracted relationship that offer services
Participating Provider
ids
Referral
premium
46. 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
Covered Expenses
(Non-par) Non-Participating Provider
Pre-existing Condition Exclusion
Beneficiary
47. 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
pcp
(UR) Utilization review
(Non-par) Non-Participating Provider
48. 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)
Allowed Expenses
Consent form
consent
Coordinated Coverage
49. 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
subscriber
(PPS) Hospital Impatient Prospective Payment System
complience
Assignment & Authorization
50. The maximum amount a plan pays for a covered service
business associate
(COB) Coordination of Benefits
authorization form
Allowed Expenses