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Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. 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
Embezzlement
Sub-acute Care
econdary Payer
Medigap Insurance
2. 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
attending physician
open panel HMO
prepaid plan
(DCI) Duplicate Coverage Inquiry
3. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Confidential communication
(PCN) Primary Care Network
Notice of Privacy Practices
(UCR) Usual - Customary and Reasonable
4. 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
Notice of Privacy Practices
Open Enrollment
(PPS) Hospital Impatient Prospective Payment System
(ERISA) Employee Retirement Income Security Act of 1974
5. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Pre-existing Condition Exclusion
prepaid plan
Amblatory Care
hmo
6. The dates of healthcare services were provided to the beneficiary
ids
Subscriber
Out of Network (OON)
(DOS) Date of Service
7. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
benefit period
cash flow
phantom billing
8. Is the provider who renders a service to a patient
Notice of Privacy Practices
Treating or performing physician
Beneficiary
Security Rule
9. Medical services provided on an outpatient basis
fraud
Open Enrollment
(Non-par) Non-Participating Provider
Amblatory Care
10. 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
attending physician
Participating Provider
(UCR) Usual - Customary and Reasonable
Embezzlement
11. A list of the amount to be paid by an insurance company for each procedure service
hmo
open panel HMO
Maximum Out Of Pocket
ee schedule
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.
(UCR) Usual - Customary and Reasonable
Medigap Insurance
(APC) Ambulatory Patient Classifications
clearinghouse
13. 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
etiquette
self-referral
Preauthorization
14. 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
(DRG's)
Experimental Procedures
(UR) Utilization review
Participating Provider
15. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
breach of confidential communication
complience plan
Network
breach of confidential communication
16. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Individually identifiable health information
Pre-certification
Medigap Insurance
17. A provision that apples when a person is covered under more than one group medical program
business associate
Referral
(COB) Coordination of Benefits
premium
18. A health insurance enrollee chooses to see an out of network provider without authorization
Medigap Insurance
security officer
Deductible
self-referral
19. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
medical foundation
complience
Embezzlement
confidentiality
20. 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
(UR) Utilization review
(PCP) Primary Care Physician
Medigap Insurance
benefit period
21. 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
(PEC) Pre-existing condition
subscriber
Maximum Out Of Pocket
22. 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
crossover claim
confidentiality
e-health information management
23. An organization of provider sites with a contracted relationship that offer services
(EPO) Exclusive Provider Organization
ids
clearinghouse
(PCN) Primary Care Network
24. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Deductible
hmo
Embezzlement
(DCI) Duplicate Coverage Inquiry
25. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
benefit period
Security Rule
Pre-certification
26. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
AMA
disclosure
Notice of Privacy Practices
27. Integrating benefits payable under more than one health insurance.
complience
Coordinated Coverage
Allowed Expenses
Consent form
28. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
covered entity
breach of confidential communication
abuse
29. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Experimental Procedures
Security Rule
premium
Network
30. 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
medical foundation
referral
Sub-acute Care
31. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
ethics
Network
preauthorization
(Non-par) Non-Participating Provider
32. Medicare's method of paying acute care hospitals for inpatient care
(PAC) Pre- Admission Certification
(PPS) Hospital Impatient Prospective Payment System
Deductible
attending physician
33. The amount of actual money available to the medical practice
cash flow
(PEC) Pre-existing condition
IIHI
(PAC) Pre- Admission Certification
34. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
state preemption
nonprivileged information
subscriber
35. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
referring physician
Consent form
self-referral
Resonable Charge
36. American Medical Association
privacy
health care provider
AMA
Protected health information
37. Individually identifiable health information
(DCI) Duplicate Coverage Inquiry
Beneficiary
confidentiality
IIHI
38. 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
business associate
ppo
(POS) Point-of Service Plan
(DCI) Duplicate Coverage Inquiry
39. Billing for services not performed
IIHI
Protected health information
IIHI
phantom billing
40. Standards of conduct generally accepted as a moral guide for behavior.
Coordinated Coverage
Pre-existing Condition Exclusion
attending physician
ethics
41. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Referral
prepaid plan
Experimental Procedures
42. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
Sub-acute Care
covered entity
ordering physician
Security Rule
43. An intentional misrepresentation of the facts to deceive or mislead another.
(COB) Coordination of Benefits
(DCI) Duplicate Coverage Inquiry
fraud
preauthorization
44. A patient claim is eligible for medicare and medicaid
Covered Expenses
crossover claim
Pre-existing Condition Exclusion
ids
45. The amount of actual money available to the medical practice
Pre-certification
cash flow
pos
Beneficiary
46. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
ids
(OOPs) Out of Pocket Costs/Expenses
Privileged information
47. Individually identifiable health information
IIHI
Individually identifiable health information
(AOB) Assignment of Benefits
Open Enrollment
48. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
premium
Assignment & Authorization
Specialist
(UR) Utilization review
49. A review of the need for inpatient hospital care - completed before the actual admission
breach of confidential communication
ids
(PAC) Pre- Admission Certification
etiquette
50. 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.
pcp
(ERISA) Employee Retirement Income Security Act of 1974
Protected health information
Deductible
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