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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. A clinic that is owned by the HMO and the physicians are employees of the HMO
complience
closed panel HMO
(COB) Coordination of Benefits
Maximum Out Of Pocket
2. The amount of actual money available to the medical practice
cash flow
Open Enrollment
consent
transaction
3. 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
crossover claim
(PCP) Primary Care Physician
(PCN) Primary Care Network
4. An intentional misrepresentation of the facts to deceive or mislead another.
Referral
Treating or performing physician
Protected health information
fraud
5. 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
ids
consulting physician
(ERISA) Employee Retirement Income Security Act of 1974
e-health information management
6. 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.
prepaid plan
Resonable Charge
Protected health information
abuse
7. 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
Referral
hmo
Assignment & Authorization
abuse
8. 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
Out of Network (OON)
Network
Sub-acute Care
Subscriber
9. 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
cash flow
premium
premium
10. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(UCR) Usual - Customary and Reasonable
benefit period
(DME) Durable Medical Equipment
(TPA) Third Party Administrator
11. Standards of conduct generally accepted as a moral guide for behavior.
ethics
pos
Assignment & Authorization
Referral
12. 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
subscriber
health care provider
attending physician
13. 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.
ee schedule
Confidential communication
business associate
IIHI
14. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
(APC) Ambulatory Patient Classifications
deductible
ee schedule
15. Individually identifiable health information
nonprivileged information
Deductible
IIHI
Amblatory Care
16. Is the provider who renders a service to a patient
Treating or performing physician
Medigap Insurance
Embezzlement
referral
17. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals
referral
Subscriber
(POS) Point-of Service Plan
Supplementary Medical Insurance
18. A monthly fee paid by the insured for specific medical insurance coverage
Treating or performing physician
(PPS) Hospital Impatient Prospective Payment System
(UR) Utilization review
premium
19. Standards of conduct generally accepted as a moral guide for behavior.
ethics
(POS) Point-of Service Plan
Participating Provider
(UCR) Usual - Customary and Reasonable
20. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Pre-certification
Out of Network (OON)
(PCP) Primary Care Physician
21. 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
security officer
deductible
Pre-existing Condition Exclusion
Network
22. A willful act by an employee of taking possession of an employer's money
electronic media
Embezzlement
Maximum Out Of Pocket
(PAC) Pre- Admission Certification
23. 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
deductible
business associate
Pre-existing Condition Exclusion
Deductible
24. 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) Primary Care Physician
(TPA) Third Party Administrator
self-referral
25. A list of the amount to be paid by an insurance company for each procedure service
Treating or performing physician
Medigap Insurance
ee schedule
etiquette
26. Approval or consent by a primary physician for patient referral to ancillary services and specialists
IIHI
claim
Referral
(POS) Point-of Service Plan
27. Medical services provided on an outpatient basis
HIPAA
breach of confidential communication
Amblatory Care
Supplementary Medical Insurance
28. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Resonable Charge
confidentiality
claim
consent
29. 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.
(EPO) Exclusive Provider Organization
Privacy officer
HIPAA
transaction
30. A review of the need for inpatient hospital care - completed before the actual admission
Preauthorization
(PAC) Pre- Admission Certification
claim
Maximum Out Of Pocket
31. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(POS) Point-of Service Plan
(APC) Ambulatory Patient Classifications
Pre-certification
Deductible
32. 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.
Notice of Privacy Practices
(DRG's)
Specialist
state preemption
33. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(UCR) Usual - Customary and Reasonable
electronic media
Maximum Out Of Pocket
ordering physician
34. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Maximum Out Of Pocket
Open Enrollment
electronic media
referring physician
35. An organization of provider sites with a contracted relationship that offer services
Subscriber
ids
Maximum Out Of Pocket
(DCI) Duplicate Coverage Inquiry
36. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
authorization form
Open Enrollment
prepaid plan
clearinghouse
37. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
preauthorization
Participating Provider
consulting physician
38. 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.
Open Enrollment
Privileged information
(EPO) Exclusive Provider Organization
Privacy officer
39. Medical staff member who is legally responsible for the care and treatment given to a patient.
Medigap Insurance
benefit period
(PCN) Primary Care Network
attending physician
40. A structure for classifying outpatient services and procedures for purpose of payment
abuse
Covered Expenses
econdary Payer
(APC) Ambulatory Patient Classifications
41. Someone who is eligible for or receiving benefits under an insurance policy or plan
privacy
Subscriber
deductible
Beneficiary
42. 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
(DME) Durable Medical Equipment
(APC) Ambulatory Patient Classifications
hmo
(Non-par) Non-Participating Provider
43. 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.
(PCN) Primary Care Network
fraud
Embezzlement
business associate
44. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Supplementary Medical Insurance
econdary Payer
Resonable Charge
Subscriber
45. 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
fraud
consent
ethics
nonprivileged information
46. The period of time that payment for Medicare inpatient hospital benefits are available
(AOB) Assignment of Benefits
Consent form
(UR) Utilization review
benefit period
47. 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
Network
Deductible
closed panel HMO
claim
48. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Open Enrollment
(DOS) Date of Service
(ERISA) Employee Retirement Income Security Act of 1974
49. A rule - condition - or requirement
Standard
Supplementary Medical Insurance
e-health information management
Preauthorization
50. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
subscriber
benefit period
Coordinated Coverage