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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. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PAC) Pre- Admission Certification
nonprivileged information
(PEC) Pre-existing condition
ordering physician
2. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
ids
cash flow
Security Rule
3. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
attending physician
Assignment & Authorization
(UCR) Usual - Customary and Reasonable
IIHI
4. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
authorization form
(OOPs) Out of Pocket Costs/Expenses
clearinghouse
referring physician
5. 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)
subscriber
subscriber
(AOB) Assignment of Benefits
Consent form
6. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Notice of Privacy Practices
econdary Payer
Referral
abuse
7. Is a provider who sends the patients for testing or treatment
Confidential communication
privacy
referring physician
etiquette
8. The maximum amount a plan pays for a covered service
breach of confidential communication
Allowed Expenses
(PAC) Pre- Admission Certification
ppo
9. The period of time that payment for Medicare inpatient hospital benefits are available
Medigap Insurance
Supplementary Medical Insurance
(POS) Point-of Service Plan
benefit period
10. A provision that apples when a person is covered under more than one group medical program
Maximum Out Of Pocket
open panel HMO
(COB) Coordination of Benefits
crossover claim
11. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
transaction
(PEC) Pre-existing condition
Specialist
Network
12. 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
(PCN) Primary Care Network
breach of confidential communication
Consent form
nonprivileged information
13. 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.
Individually identifiable health information
electronic media
open panel HMO
Notice of Privacy Practices
14. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
15. A rule - condition - or requirement
Pre-certification
Standard
ee schedule
Pre-existing Condition Exclusion
16. 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
attending physician
Out of Network (OON)
pos
clearinghouse
17. 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
Out of Network (OON)
Claim
prepaid plan
privacy
18. 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
premium
Supplementary Medical Insurance
authorization form
prepaid plan
19. 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.
closed panel HMO
(UCR) Usual - Customary and Reasonable
(PAC) Pre- Admission Certification
Protected health information
20. 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 officer
hmo
disclosure
(PCP) Primary Care Physician
21. 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
(POS) Point-of Service Plan
ppo
(PEC) Pre-existing condition
complience
22. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Covered Expenses
crossover claim
confidentiality
covered entity
23. Integrating benefits payable under more than one health insurance.
cash flow
state preemption
Coordinated Coverage
hmo
24. Medical services provided on an outpatient basis
HIPAA
Amblatory Care
disclosure
(COB) Coordination of Benefits
25. An organization of provider sites with a contracted relationship that offer services
electronic media
Experimental Procedures
ids
fraud
26. A patient claim is eligible for medicare and medicaid
ethics
attending physician
premium
crossover claim
27. The maximum amount a plan pays for a covered service
Treating or performing physician
Allowed Expenses
Protected health information
ids
28. 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
(PCP) Primary Care Physician
Covered Expenses
crossover claim
(AOB) Assignment of Benefits
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
Assignment & Authorization
ee schedule
fraud
Maximum Out Of Pocket
30. 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
Allowed Expenses
ids
(DCI) Duplicate Coverage Inquiry
31. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Privileged information
etiquette
(TPA) Third Party Administrator
confidentiality
32. 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
IIHI
abuse
(COBRA)
Security Rule
33. American Medical Association
Specialist
AMA
(Non-par) Non-Participating Provider
Privacy officer
34. 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
privacy
(UR) Utilization review
(PAC) Pre- Admission Certification
35. 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
pos
(PAC) Pre- Admission Certification
Treating or performing physician
(DRG's)
36. 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
Protected health information
(POS) Point-of Service Plan
(ABN) Advance Beneficiary Notice
econdary Payer
37. 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)
self-referral
Consent form
ethics
HIPAA
38. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Individually identifiable health information
complience
attending physician
(TPA) Third Party Administrator
39. 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
consent
ppo
Assignment & Authorization
abuse
40. 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)
pos
Medigap Insurance
medical foundation
41. 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.
Notice of Privacy Practices
econdary Payer
Beneficiary
privacy
42. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Medigap Insurance
Confidential communication
transaction
43. Individually identifiable health information
Covered Expenses
IIHI
Assignment & Authorization
Treating or performing physician
44. 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.
(ABN) Advance Beneficiary Notice
ordering physician
state preemption
(POS) Point-of Service Plan
45. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
subscriber
clearinghouse
(OOPs) Out of Pocket Costs/Expenses
46. 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
ppo
prepaid plan
open panel HMO
crossover claim
47. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
fraud
Assignment & Authorization
deductible
(PEC) Pre-existing condition
48. 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
Referral
(ERISA) Employee Retirement Income Security Act of 1974
(POS) Point-of Service Plan
(PAC) Pre- Admission Certification
49. Individually identifiable health information
Resonable Charge
closed panel HMO
IIHI
ee schedule
50. 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
(PCP) Primary Care Physician
complience
Specialist
Preauthorization