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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. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
preauthorization
Out of Network (OON)
Allowed Expenses
ordering physician
2. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
nonprivileged information
(POS) Point-of Service Plan
e-health information management
(OOPs) Out of Pocket Costs/Expenses
3. 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.
Participating Provider
closed panel HMO
business associate
IIHI
4. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
(PCN) Primary Care Network
(PEC) Pre-existing condition
(UR) Utilization review
Sub-acute Care
5. 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
e-health information management
prepaid plan
(UR) Utilization review
consulting physician
6. 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.
(POS) Point-of Service Plan
(ERISA) Employee Retirement Income Security Act of 1974
Pre-existing Condition Exclusion
state preemption
7. 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
econdary Payer
Privileged information
attending physician
Individually identifiable health information
8. The period of time that payment for Medicare inpatient hospital benefits are available
(ABN) Advance Beneficiary Notice
(TPA) Third Party Administrator
nonprivileged information
benefit period
9. 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.
Protected health information
(DME) Durable Medical Equipment
authorization form
state preemption
10. 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
Sub-acute Care
Out of Network (OON)
prepaid plan
epo
11. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
state preemption
(TPA) Third Party Administrator
e-health information management
referral
12. 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.
business associate
(ABN) Advance Beneficiary Notice
(COBRA)
hmo
13. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
Security Rule
(Non-par) Non-Participating Provider
self-referral
14. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(UR) Utilization review
confidentiality
Assignment & Authorization
Embezzlement
15. An intentional misrepresentation of the facts to deceive or mislead another.
closed panel HMO
business associate
fraud
Consent form
16. Medicare's method of paying acute care hospitals for inpatient care
Covered Expenses
(PPS) Hospital Impatient Prospective Payment System
econdary Payer
complience plan
17. 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
ppo
(ERISA) Employee Retirement Income Security Act of 1974
(PCP) Primary Care Physician
covered entity
18. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Protected health information
HIPAA
prepaid plan
complience
19. 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
(PCN) Primary Care Network
complience
(ERISA) Employee Retirement Income Security Act of 1974
20. 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
Notice of Privacy Practices
Network
(POS) Point-of Service Plan
authorization form
21. Billing for services not performed
Out of Network (OON)
phantom billing
(ABN) Advance Beneficiary Notice
Medigap Insurance
22. 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
etiquette
ids
Network
(Non-par) Non-Participating Provider
23. 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
Privileged information
Experimental Procedures
Specialist
Medigap Insurance
24. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
IIHI
Claim
Supplementary Medical Insurance
medical foundation
25. A willful act by an employee of taking possession of an employer's money
Covered Expenses
complience
Embezzlement
(APC) Ambulatory Patient Classifications
26. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
ethics
(DCI) Duplicate Coverage Inquiry
hmo
Amblatory Care
27. 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.
Consent form
transaction
Privacy officer
Treating or performing physician
28. Health Information Portability and Accountability Act
Out of Network (OON)
HIPAA
claim
(PCN) Primary Care Network
29. An organization of provider sites with a contracted relationship that offer services
(DME) Durable Medical Equipment
(APC) Ambulatory Patient Classifications
ids
(ABN) Advance Beneficiary Notice
30. A monthly fee paid by the insured for specific medical insurance coverage
pcp
(DRG's)
premium
Referral
31. 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
prepaid plan
crossover claim
complience plan
health care provider
32. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
ids
premium
Claim
complience plan
33. 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
(UR) Utilization review
abuse
(TPA) Third Party Administrator
34. 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
security officer
Subscriber
(AOB) Assignment of Benefits
(DME) Durable Medical Equipment
35. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
disclosure
Covered Expenses
(TPA) Third Party Administrator
Experimental Procedures
36. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(UCR) Usual - Customary and Reasonable
Referral
Supplementary Medical Insurance
premium
37. A nonprofit integrated delivery system
health care provider
Referral
Participating Provider
medical foundation
38. 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
Privacy officer
referral
ee schedule
39. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Treating or performing physician
(DCI) Duplicate Coverage Inquiry
(PEC) Pre-existing condition
Privileged information
40. A rule - condition - or requirement
(PAC) Pre- Admission Certification
(DRG's)
Standard
referral
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
(COBRA)
referral
(ERISA) Employee Retirement Income Security Act of 1974
etiquette
42. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Allowed Expenses
(DME) Durable Medical Equipment
Security Rule
43. 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.
privacy
authorization form
Notice of Privacy Practices
health care provider
44. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
crossover claim
(DRG's)
Amblatory Care
45. 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
(PEC) Pre-existing condition
Privileged information
(AOB) Assignment of Benefits
(EPO) Exclusive Provider Organization
46. A privileged communication that may be disclosed only with the patient's permission.
Covered Expenses
attending physician
Confidential communication
ee schedule
47. 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.
(ERISA) Employee Retirement Income Security Act of 1974
deductible
(DCI) Duplicate Coverage Inquiry
Notice of Privacy Practices
48. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Medigap Insurance
complience
Protected health information
49. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(APC) Ambulatory Patient Classifications
Deductible
Network
referring physician
50. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
consulting physician
ids
ee schedule
confidentiality