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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. 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
Claim
self-referral
(ERISA) Employee Retirement Income Security Act of 1974
HIPAA
2. Someone who is eligible for or receiving benefits under an insurance policy or plan
epo
Beneficiary
Consent form
Assignment & Authorization
3. 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
(DME) Durable Medical Equipment
crossover claim
Sub-acute Care
Allowed Expenses
4. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Privacy officer
clearinghouse
ee schedule
referral
5. 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
nonprivileged information
Pre-existing Condition Exclusion
hmo
(PAC) Pre- Admission Certification
6. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
deductible
phantom billing
Medigap Insurance
(PAC) Pre- Admission Certification
7. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
HIPAA
privacy
closed panel HMO
8. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
econdary Payer
ordering physician
(PAC) Pre- Admission Certification
Out of Network (OON)
9. Is the provider who renders a service to a patient
Treating or performing physician
complience
Referral
pcp
10. 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
closed panel HMO
Open Enrollment
Pre-existing Condition Exclusion
medical foundation
11. 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
transaction
(POS) Point-of Service Plan
Maximum Out Of Pocket
(DME) Durable Medical Equipment
12. The transmission of information between two parties to carry out financial or administrative activities related to health care.
ids
disclosure
transaction
preauthorization
13. 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
premium
(PAC) Pre- Admission Certification
ppo
medical foundation
14. 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
ordering physician
Coordinated Coverage
ee schedule
15. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(EPO) Exclusive Provider Organization
claim
ordering physician
(UR) Utilization review
16. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
claim
(PCN) Primary Care Network
Pre-certification
Medigap Insurance
17. The dates of healthcare services were provided to the beneficiary
subscriber
Coordinated Coverage
(DOS) Date of Service
electronic media
18. 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
Pre-existing Condition Exclusion
transaction
consulting physician
Subscriber
19. An intentional misrepresentation of the facts to deceive or mislead another.
(PCN) Primary Care Network
e-health information management
fraud
(DOS) Date of Service
20. 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
premium
(ERISA) Employee Retirement Income Security Act of 1974
Sub-acute Care
21. Standards of conduct generally accepted as a moral guide for behavior.
Assignment & Authorization
ethics
pos
Participating Provider
22. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Subscriber
business associate
Network
Claim
23. A willful act by an employee of taking possession of an employer's money
epo
electronic media
(PAC) Pre- Admission Certification
Embezzlement
24. 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
(DOS) Date of Service
fraud
(PCP) Primary Care Physician
econdary Payer
25. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
consulting physician
Privileged information
Medigap Insurance
26. 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
open panel HMO
Subscriber
Treating or performing physician
Referral
27. The period of time that payment for Medicare inpatient hospital benefits are available
(UCR) Usual - Customary and Reasonable
Protected health information
benefit period
referring physician
28. Health Information Portability and Accountability Act
(DRG's)
Allowed Expenses
Deductible
HIPAA
29. Unauthorized release of information
subscriber
ids
(OOPs) Out of Pocket Costs/Expenses
breach of confidential communication
30. 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
(UCR) Usual - Customary and Reasonable
(AOB) Assignment of Benefits
Out of Network (OON)
(TPA) Third Party Administrator
31. Individually identifiable health information
IIHI
disclosure
(DOS) Date of Service
ppo
32. Medicare's method of paying acute care hospitals for inpatient care
IIHI
(PPS) Hospital Impatient Prospective Payment System
Treating or performing physician
(ABN) Advance Beneficiary Notice
33. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
34. The maximum amount a plan pays for a covered service
Allowed Expenses
Subscriber
hmo
complience plan
35. Medical services provided on an outpatient basis
premium
Consent form
security officer
Amblatory Care
36. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(EPO) Exclusive Provider Organization
Resonable Charge
Assignment & Authorization
etiquette
37. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
deductible
open panel HMO
subscriber
Deductible
38. 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.
covered entity
Amblatory Care
state preemption
Pre-certification
39. 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.
health care provider
pcp
(PCP) Primary Care Physician
Participating Provider
40. 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
Out of Network (OON)
complience
pos
Protected health information
41. 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
pos
phantom billing
self-referral
authorization form
42. Medical services provided on an outpatient basis
Amblatory Care
Allowed Expenses
nonprivileged information
HIPAA
43. 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
IIHI
ppo
(PAC) Pre- Admission Certification
44. 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
(EPO) Exclusive Provider Organization
Covered Expenses
(DME) Durable Medical Equipment
45. What the insurance company will consider paying for as defined in the contract.
(DME) Durable Medical Equipment
closed panel HMO
Covered Expenses
Out of Network (OON)
46. A provision that apples when a person is covered under more than one group medical program
(PAC) Pre- Admission Certification
referring physician
ppo
(COB) Coordination of Benefits
47. 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
e-health information management
(PCN) Primary Care Network
(EPO) Exclusive Provider Organization
Assignment & Authorization
48. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
complience
abuse
Experimental Procedures
consulting physician
49. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Protected health information
Subscriber
Embezzlement
premium
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
Preauthorization
disclosure
ee schedule
(AOB) Assignment of Benefits