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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 physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
AMA
(EPO) Exclusive Provider Organization
Allowed Expenses
Specialist
2. Health Information Portability and Accountability Act
Privileged information
(ABN) Advance Beneficiary Notice
HIPAA
Network
3. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(DCI) Duplicate Coverage Inquiry
Supplementary Medical Insurance
Experimental Procedures
Referral
4. 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
(PPS) Hospital Impatient Prospective Payment System
breach of confidential communication
Assignment & Authorization
authorization form
5. Someone who is eligible for or receiving benefits under an insurance policy or plan
ids
Referral
(OOPs) Out of Pocket Costs/Expenses
Beneficiary
6. A structure for classifying outpatient services and procedures for purpose of payment
prepaid plan
(APC) Ambulatory Patient Classifications
business associate
ids
7. 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
(OOPs) Out of Pocket Costs/Expenses
fraud
(DOS) Date of Service
Deductible
8. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
Beneficiary
Coordinated Coverage
covered entity
9. 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
Coordinated Coverage
Open Enrollment
security officer
10. The amount of actual money available to the medical practice
complience
Sub-acute Care
(DRG's)
cash flow
11. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
covered entity
AMA
e-health information management
hmo
12. Health Information Portability and Accountability Act
Standard
epo
complience plan
HIPAA
13. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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14. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
epo
hmo
(UCR) Usual - Customary and Reasonable
claim
15. 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
hmo
Notice of Privacy Practices
benefit period
16. A review of the need for inpatient hospital care - completed before the actual admission
prepaid plan
authorization form
(PAC) Pre- Admission Certification
epo
17. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Individually identifiable health information
confidentiality
Medigap Insurance
Allowed Expenses
18. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
consent
closed panel HMO
Beneficiary
Resonable Charge
19. 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
prepaid plan
Coordinated Coverage
Privileged information
Maximum Out Of Pocket
20. The condition of being secluded from the presence or view of others.
(AOB) Assignment of Benefits
(TPA) Third Party Administrator
privacy
Network
21. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
crossover claim
ids
ordering physician
Covered Expenses
22. American Medical Association
AMA
ids
(OOPs) Out of Pocket Costs/Expenses
(APC) Ambulatory Patient Classifications
23. Individually identifiable health information
Confidential communication
Treating or performing physician
IIHI
(DME) Durable Medical Equipment
24. 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
epo
(APC) Ambulatory Patient Classifications
security officer
Assignment & Authorization
25. Medical staff member who is legally responsible for the care and treatment given to a patient.
Open Enrollment
preauthorization
(EPO) Exclusive Provider Organization
attending physician
26. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
claim
attending physician
complience
Standard
27. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
Sub-acute Care
pos
Security Rule
28. 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
(Non-par) Non-Participating Provider
Standard
premium
Pre-existing Condition Exclusion
29. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
econdary Payer
IIHI
nonprivileged information
(DCI) Duplicate Coverage Inquiry
30. A list of the amount to be paid by an insurance company for each procedure service
Notice of Privacy Practices
(UCR) Usual - Customary and Reasonable
ee schedule
(AOB) Assignment of Benefits
31. The dates of healthcare services were provided to the beneficiary
Participating Provider
(DME) Durable Medical Equipment
(ERISA) Employee Retirement Income Security Act of 1974
(DOS) Date of Service
32. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
abuse
covered entity
Resonable Charge
(PAC) Pre- Admission Certification
33. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
ordering physician
Subscriber
IIHI
34. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Experimental Procedures
(DCI) Duplicate Coverage Inquiry
AMA
(EPO) Exclusive Provider Organization
35. A nonprofit integrated delivery system
(DCI) Duplicate Coverage Inquiry
(APC) Ambulatory Patient Classifications
(PCN) Primary Care Network
medical foundation
36. 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.
(APC) Ambulatory Patient Classifications
Privileged information
crossover claim
privacy
37. 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.
Deductible
Deductible
(TPA) Third Party Administrator
Protected health information
38. What the insurance company will consider paying for as defined in the contract.
Subscriber
Covered Expenses
(DCI) Duplicate Coverage Inquiry
breach of confidential communication
39. An organization of provider sites with a contracted relationship that offer services
ee schedule
ids
preauthorization
Participating Provider
40. A review of the need for inpatient hospital care - completed before the actual admission
state preemption
(ABN) Advance Beneficiary Notice
(PAC) Pre- Admission Certification
(POS) Point-of Service Plan
41. The maximum amount a plan pays for a covered service
privacy
subscriber
consulting physician
Allowed Expenses
42. 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 officer
Amblatory Care
attending physician
econdary Payer
43. A provision that apples when a person is covered under more than one group medical program
Participating Provider
disclosure
(COB) Coordination of Benefits
(UCR) Usual - Customary and Reasonable
44. 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
Medigap Insurance
crossover claim
Open Enrollment
Treating or performing physician
45. 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.
Pre-existing Condition Exclusion
cash flow
Privacy officer
complience
46. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(COB) Coordination of Benefits
(PEC) Pre-existing condition
ordering physician
business associate
47. A patient claim is eligible for medicare and medicaid
(ABN) Advance Beneficiary Notice
ordering physician
Individually identifiable health information
crossover claim
48. 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.
IIHI
Privacy officer
referral
referring physician
49. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Resonable Charge
ids
(ERISA) Employee Retirement Income Security Act of 1974
50. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(COB) Coordination of Benefits
(PCN) Primary Care Network
Network
hmo