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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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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. The maximum amount a plan pays for a covered service
Experimental Procedures
Consent form
abuse
Allowed Expenses
2. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Individually identifiable health information
hmo
epo
Pre-certification
3. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
HIPAA
(UCR) Usual - Customary and Reasonable
pcp
Protected health information
4. 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
(PCN) Primary Care Network
Security Rule
ee schedule
authorization form
5. 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
Beneficiary
health care provider
Confidential communication
6. The condition of being secluded from the presence or view of others.
disclosure
(DME) Durable Medical Equipment
privacy
Maximum Out Of Pocket
7. 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.
(PEC) Pre-existing condition
attending physician
self-referral
Privacy officer
8. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
ee schedule
Assignment & Authorization
hmo
Sub-acute Care
9. Billing for services not performed
Standard
(OOPs) Out of Pocket Costs/Expenses
preauthorization
phantom billing
10. 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
ppo
abuse
Medigap Insurance
(Non-par) Non-Participating Provider
11. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
referral
Allowed Expenses
nonprivileged information
12. 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.
(PCN) Primary Care Network
Notice of Privacy Practices
Specialist
(OOPs) Out of Pocket Costs/Expenses
13. 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
ethics
closed panel HMO
epo
authorization form
14. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
(PPS) Hospital Impatient Prospective Payment System
privacy
Specialist
15. 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.
(POS) Point-of Service Plan
Privileged information
Security Rule
cash flow
16. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(PAC) Pre- Admission Certification
(EPO) Exclusive Provider Organization
Maximum Out Of Pocket
confidentiality
17. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
nonprivileged information
(PCP) Primary Care Physician
Beneficiary
(ERISA) Employee Retirement Income Security Act of 1974
18. 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.
ethics
clearinghouse
Covered Expenses
business associate
19. Is the provider who renders a service to a patient
(PCN) Primary Care Network
Treating or performing physician
Privileged information
Specialist
20. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(APC) Ambulatory Patient Classifications
premium
subscriber
medical foundation
21. 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
Beneficiary
(DOS) Date of Service
Maximum Out Of Pocket
Protected health information
22. A clinic that is owned by the HMO and the physicians are employees of the HMO
Covered Expenses
closed panel HMO
hmo
Experimental Procedures
23. Medicare's method of paying acute care hospitals for inpatient care
nonprivileged information
(OOPs) Out of Pocket Costs/Expenses
consent
(PPS) Hospital Impatient Prospective Payment System
24. Individually identifiable health information
IIHI
Specialist
Medigap Insurance
Security Rule
25. Customs - rules of conduct - courtesy - and manners of the medical profession
disclosure
referring physician
complience
etiquette
26. 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.
business associate
ee schedule
Privileged information
AMA
27. 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
Coordinated Coverage
epo
claim
28. 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.
epo
(COBRA)
clearinghouse
Protected health information
29. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
covered entity
(PAC) Pre- Admission Certification
epo
(UCR) Usual - Customary and Reasonable
30. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
confidentiality
Open Enrollment
(DME) Durable Medical Equipment
31. 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
Out of Network (OON)
deductible
Privacy officer
32. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Pre-certification
Confidential communication
nonprivileged information
e-health information management
33. 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
complience plan
crossover claim
Open Enrollment
(POS) Point-of Service Plan
34. 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
nonprivileged information
(ABN) Advance Beneficiary Notice
Protected health information
Security Rule
35. American Medical Association
AMA
health care provider
Resonable Charge
(DOS) Date of Service
36. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
(COBRA)
Covered Expenses
Specialist
Individually identifiable health information
37. Someone who is eligible for or receiving benefits under an insurance policy or plan
benefit period
Beneficiary
Allowed Expenses
Sub-acute Care
38. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(PCN) Primary Care Network
complience
Assignment & Authorization
Medigap Insurance
39. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Covered Expenses
crossover claim
consulting physician
ordering physician
40. 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
pcp
ee schedule
health care provider
41. 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.
Protected health information
Subscriber
cash flow
(PCP) Primary Care Physician
42. Medical services provided on an outpatient basis
pos
(DOS) Date of Service
Notice of Privacy Practices
Amblatory Care
43. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
(ABN) Advance Beneficiary Notice
nonprivileged information
Subscriber
44. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
transaction
Medigap Insurance
(PPS) Hospital Impatient Prospective Payment System
45. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
Specialist
referring physician
Amblatory Care
46. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
attending physician
referral
(TPA) Third Party Administrator
47. Integrating benefits payable under more than one health insurance.
(UR) Utilization review
(ERISA) Employee Retirement Income Security Act of 1974
(PEC) Pre-existing condition
Coordinated Coverage
48. 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
Subscriber
Participating Provider
confidentiality
Specialist
49. 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
hmo
Pre-existing Condition Exclusion
Out of Network (OON)
crossover claim
50. 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
Allowed Expenses
(ABN) Advance Beneficiary Notice
deductible
pos
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