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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.
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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. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Beneficiary
transaction
authorization form
2. Is the provider who renders a service to a patient
electronic media
Open Enrollment
Treating or performing physician
preauthorization
3. Medical services provided on an outpatient basis
transaction
self-referral
Amblatory Care
ids
4. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(OOPs) Out of Pocket Costs/Expenses
Medigap Insurance
Maximum Out Of Pocket
electronic media
5. 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
Maximum Out Of Pocket
prepaid plan
security officer
6. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
Standard
complience
Pre-existing Condition Exclusion
7. Is a provider who sends the patients for testing or treatment
privacy
ethics
Security Rule
referring physician
8. 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
(DOS) Date of Service
Standard
health care provider
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)
electronic media
Consent form
business associate
(ERISA) Employee Retirement Income Security Act of 1974
10. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Privacy officer
Notice of Privacy Practices
ordering physician
claim
11. The period of time that payment for Medicare inpatient hospital benefits are available
(APC) Ambulatory Patient Classifications
Individually identifiable health information
(Non-par) Non-Participating Provider
benefit period
12. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
hmo
(TPA) Third Party Administrator
(POS) Point-of Service Plan
open panel HMO
13. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
referral
prepaid plan
Confidential communication
transaction
14. 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
Sub-acute Care
Preauthorization
Referral
Maximum Out Of Pocket
15. 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
(EPO) Exclusive Provider Organization
Experimental Procedures
ethics
Allowed Expenses
16. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
claim
crossover claim
Standard
(OOPs) Out of Pocket Costs/Expenses
17. 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.
state preemption
(PCP) Primary Care Physician
health care provider
(PAC) Pre- Admission Certification
18. 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
ppo
(ABN) Advance Beneficiary Notice
Pre-existing Condition Exclusion
(OOPs) Out of Pocket Costs/Expenses
19. 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
hmo
(DME) Durable Medical Equipment
(PCN) Primary Care Network
20. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
Resonable Charge
(COBRA)
pcp
21. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
phantom billing
claim
electronic media
Assignment & Authorization
22. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Preauthorization
(ABN) Advance Beneficiary Notice
prepaid plan
Subscriber
23. 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.
Deductible
Allowed Expenses
breach of confidential communication
Notice of Privacy Practices
24. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Protected health information
complience plan
Individually identifiable health information
Medigap Insurance
25. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
health care provider
(PPS) Hospital Impatient Prospective Payment System
Specialist
(COB) Coordination of Benefits
26. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
(UCR) Usual - Customary and Reasonable
Participating Provider
nonprivileged information
27. 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
health care provider
cash flow
Assignment & Authorization
Consent form
28. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
confidentiality
AMA
(UCR) Usual - Customary and Reasonable
29. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
(OOPs) Out of Pocket Costs/Expenses
Privacy officer
Specialist
(POS) Point-of Service Plan
30. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
ethics
(DRG's)
(Non-par) Non-Participating Provider
31. 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
(ERISA) Employee Retirement Income Security Act of 1974
econdary Payer
(COBRA)
e-health information management
32. A provision that apples when a person is covered under more than one group medical program
epo
Notice of Privacy Practices
(ABN) Advance Beneficiary Notice
(COB) Coordination of Benefits
33. Medical services provided on an outpatient basis
clearinghouse
fraud
Amblatory Care
abuse
34. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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35. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
pos
(PEC) Pre-existing condition
open panel HMO
(UCR) Usual - Customary and Reasonable
36. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Claim
etiquette
IIHI
deductible
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.
Privacy officer
claim
ethics
Maximum Out Of Pocket
38. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Protected health information
hmo
claim
Assignment & Authorization
39. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Maximum Out Of Pocket
electronic media
abuse
40. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
referring physician
ordering physician
pos
Medigap Insurance
41. 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
Privacy officer
claim
closed panel HMO
42. 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.
ppo
hmo
(ABN) Advance Beneficiary Notice
security officer
43. The maximum amount a plan pays for a covered service
consulting physician
Allowed Expenses
(AOB) Assignment of Benefits
(PCP) Primary Care Physician
44. Individually identifiable health information
disclosure
confidentiality
IIHI
Confidential communication
45. Health Information Portability and Accountability Act
Sub-acute Care
Claim
Privacy officer
HIPAA
46. 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
(ERISA) Employee Retirement Income Security Act of 1974
Participating Provider
(TPA) Third Party Administrator
(PAC) Pre- Admission Certification
47. The dates of healthcare services were provided to the beneficiary
(TPA) Third Party Administrator
referral
business associate
(DOS) Date of Service
48. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
cash flow
nonprivileged information
privacy
Claim
49. American Medical Association
subscriber
Protected health information
AMA
complience
50. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
crossover claim
ppo
claim
Assignment & Authorization
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