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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. 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
Experimental Procedures
open panel HMO
Sub-acute Care
AMA
2. Unauthorized release of information
Notice of Privacy Practices
breach of confidential communication
deductible
(ABN) Advance Beneficiary Notice
3. 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.
cash flow
state preemption
Notice of Privacy Practices
security officer
4. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
covered entity
referring physician
(PEC) Pre-existing condition
5. A privileged communication that may be disclosed only with the patient's permission.
Protected health information
Confidential communication
AMA
Privileged information
6. Medicare's method of paying acute care hospitals for inpatient care
(POS) Point-of Service Plan
Embezzlement
business associate
(PPS) Hospital Impatient Prospective Payment System
7. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Supplementary Medical Insurance
Network
consulting physician
Deductible
8. 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
Consent form
prepaid plan
(UR) Utilization review
AMA
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)
preauthorization
Consent form
ppo
Referral
10. 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
Experimental Procedures
nonprivileged information
(TPA) Third Party Administrator
11. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Allowed Expenses
abuse
(UCR) Usual - Customary and Reasonable
Beneficiary
12. 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
Coordinated Coverage
Assignment & Authorization
Consent form
covered entity
13. A provision that apples when a person is covered under more than one group medical program
Covered Expenses
fraud
(PAC) Pre- Admission Certification
(COB) Coordination of Benefits
14. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
epo
fraud
(PEC) Pre-existing condition
Embezzlement
15. A review of the need for inpatient hospital care - completed before the actual admission
(DCI) Duplicate Coverage Inquiry
confidentiality
(PAC) Pre- Admission Certification
nonprivileged information
16. 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)
Consent form
Resonable Charge
(PAC) Pre- Admission Certification
health care provider
17. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
Network
benefit period
consent
18. Individually identifiable health information
phantom billing
ethics
IIHI
Amblatory Care
19. A list of the amount to be paid by an insurance company for each procedure service
business associate
Covered Expenses
ee schedule
(APC) Ambulatory Patient Classifications
20. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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21. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
(COBRA)
Privileged information
(UR) Utilization review
22. Is a provider who sends the patients for testing or treatment
referring physician
Claim
claim
(ABN) Advance Beneficiary Notice
23. 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.
Deductible
Covered Expenses
ppo
state preemption
24. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Privileged information
claim
ethics
self-referral
25. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
(DOS) Date of Service
(PAC) Pre- Admission Certification
Consent form
26. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Preauthorization
(AOB) Assignment of Benefits
(UR) Utilization review
27. Medicare's method of paying acute care hospitals for inpatient care
(EPO) Exclusive Provider Organization
Security Rule
(ABN) Advance Beneficiary Notice
(PPS) Hospital Impatient Prospective Payment System
28. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Privacy officer
abuse
disclosure
(DRG's)
29. 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
epo
cash flow
Consent form
30. American Medical Association
Supplementary Medical Insurance
Medigap Insurance
consent
AMA
31. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
(APC) Ambulatory Patient Classifications
Assignment & Authorization
ppo
Open Enrollment
32. 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
ee schedule
Open Enrollment
Security Rule
Pre-certification
33. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(POS) Point-of Service Plan
Covered Expenses
Notice of Privacy Practices
34. Customs - rules of conduct - courtesy - and manners of the medical profession
cash flow
Notice of Privacy Practices
(DRG's)
etiquette
35. 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
ordering physician
security officer
Preauthorization
36. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Confidential communication
open panel HMO
consulting physician
(OOPs) Out of Pocket Costs/Expenses
37. 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
authorization form
(OOPs) Out of Pocket Costs/Expenses
Security Rule
nonprivileged information
38. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(PPS) Hospital Impatient Prospective Payment System
fraud
Subscriber
(PEC) Pre-existing condition
39. 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
epo
clearinghouse
privacy
open panel HMO
40. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(DOS) Date of Service
Resonable Charge
privacy
pcp
41. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Out of Network (OON)
ordering physician
Treating or performing physician
electronic media
42. 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
(AOB) Assignment of Benefits
(DOS) Date of Service
benefit period
Assignment & Authorization
43. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Standard
(PEC) Pre-existing condition
Experimental Procedures
pcp
44. 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.
(EPO) Exclusive Provider Organization
Participating Provider
(ERISA) Employee Retirement Income Security Act of 1974
Privileged information
45. 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
epo
referring physician
(PPS) Hospital Impatient Prospective Payment System
state preemption
46. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
ee schedule
(EPO) Exclusive Provider Organization
Confidential communication
etiquette
47. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
ee schedule
fraud
referring physician
Medigap Insurance
48. Health Information Portability and Accountability Act
econdary Payer
HIPAA
ordering physician
phantom billing
49. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
privacy
cash flow
subscriber
deductible
50. 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
(DCI) Duplicate Coverage Inquiry
Covered Expenses
Medigap Insurance