SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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 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
Security Rule
attending physician
Amblatory Care
2. 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
ethics
Individually identifiable health information
open panel HMO
business associate
3. 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
privacy
business associate
econdary Payer
4. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
consulting physician
health care provider
subscriber
(TPA) Third Party Administrator
5. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Protected health information
(PEC) Pre-existing condition
(PPS) Hospital Impatient Prospective Payment System
referral
6. 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
(PCP) Primary Care Physician
open panel HMO
(DRG's)
7. Is a provider who sends the patients for testing or treatment
Pre-existing Condition Exclusion
Standard
consent
referring physician
8. The dates of healthcare services were provided to the beneficiary
Confidential communication
fraud
(EPO) Exclusive Provider Organization
(DOS) Date of Service
9. 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
Allowed Expenses
ethics
epo
(Non-par) Non-Participating Provider
10. Medical staff member who is legally responsible for the care and treatment given to a patient.
Consent form
consent
(DRG's)
attending physician
11. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
state preemption
Referral
nonprivileged information
12. 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
Deductible
(PCP) Primary Care Physician
pcp
Participating Provider
13. A review of the need for inpatient hospital care - completed before the actual admission
(POS) Point-of Service Plan
deductible
(PAC) Pre- Admission Certification
AMA
14. 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
preauthorization
pcp
Specialist
open panel HMO
15. 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
(PPS) Hospital Impatient Prospective Payment System
Open Enrollment
pos
phantom billing
16. A list of the amount to be paid by an insurance company for each procedure service
(COBRA)
ee schedule
(POS) Point-of Service Plan
(DRG's)
17. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
open panel HMO
Claim
(DCI) Duplicate Coverage Inquiry
health care provider
18. 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
(PPS) Hospital Impatient Prospective Payment System
(PCP) Primary Care Physician
pos
19. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
cash flow
(ABN) Advance Beneficiary Notice
e-health information management
ee schedule
20. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
crossover claim
IIHI
referring physician
ordering physician
21. Unauthorized release of information
breach of confidential communication
crossover claim
Allowed Expenses
crossover claim
22. Standards of conduct generally accepted as a moral guide for behavior.
health care provider
fraud
ethics
preauthorization
23. Billing for services not performed
(UCR) Usual - Customary and Reasonable
phantom billing
(PCP) Primary Care Physician
e-health information management
24. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
covered entity
(POS) Point-of Service Plan
hmo
(DCI) Duplicate Coverage Inquiry
25. 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
(UCR) Usual - Customary and Reasonable
covered entity
(AOB) Assignment of Benefits
(POS) Point-of Service Plan
26. Verbal or written agreement that gives approval to some action - situation - or statement.
complience plan
consent
Supplementary Medical Insurance
Participating Provider
27. 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
(ABN) Advance Beneficiary Notice
Experimental Procedures
Privacy officer
pos
28. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
privacy
hmo
abuse
AMA
29. A review of the need for inpatient hospital care - completed before the actual admission
IIHI
ethics
(PAC) Pre- Admission Certification
authorization form
30. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Notice of Privacy Practices
Subscriber
Coordinated Coverage
31. An organization of provider sites with a contracted relationship that offer services
(APC) Ambulatory Patient Classifications
(PPS) Hospital Impatient Prospective Payment System
(AOB) Assignment of Benefits
ids
32. A clinic that is owned by the HMO and the physicians are employees of the HMO
ordering physician
closed panel HMO
pcp
Open Enrollment
33. 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.
Privileged information
business associate
pcp
authorization form
34. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
Preauthorization
(COB) Coordination of Benefits
Embezzlement
Deductible
35. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment
(DME) Durable Medical Equipment
(COB) Coordination of Benefits
medical foundation
Beneficiary
36. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Supplementary Medical Insurance
Open Enrollment
Referral
37. Standards of conduct generally accepted as a moral guide for behavior.
ethics
(PPS) Hospital Impatient Prospective Payment System
e-health information management
pcp
38. 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
Supplementary Medical Insurance
medical foundation
Out of Network (OON)
39. The period of time that payment for Medicare inpatient hospital benefits are available
e-health information management
(POS) Point-of Service Plan
Confidential communication
benefit period
40. 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.
benefit period
cash flow
security officer
authorization form
41. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
crossover claim
Referral
(EPO) Exclusive Provider Organization
confidentiality
42. A structure for classifying outpatient services and procedures for purpose of payment
electronic media
Standard
HIPAA
(APC) Ambulatory Patient Classifications
43. What the insurance company will consider paying for as defined in the contract.
(EPO) Exclusive Provider Organization
Covered Expenses
complience
Out of Network (OON)
44. Unauthorized release of information
open panel HMO
health care provider
breach of confidential communication
(EPO) Exclusive Provider Organization
45. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Maximum Out Of Pocket
(PEC) Pre-existing condition
authorization form
46. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(AOB) Assignment of Benefits
Consent form
hmo
Network
47. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
referring physician
privacy
Coordinated Coverage
preauthorization
48. 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
Medigap Insurance
ee schedule
abuse
49. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
authorization form
Specialist
complience plan
50. 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)
closed panel HMO
(APC) Ambulatory Patient Classifications
ethics