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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.
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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 physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
consent
Specialist
(ERISA) Employee Retirement Income Security Act of 1974
Covered Expenses
2. 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
complience
Referral
Supplementary Medical Insurance
Claim
3. Health Information Portability and Accountability Act
Standard
referring physician
HIPAA
breach of confidential communication
4. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(ABN) Advance Beneficiary Notice
(APC) Ambulatory Patient Classifications
transaction
Participating Provider
5. What the insurance company will consider paying for as defined in the contract.
Supplementary Medical Insurance
consent
Covered Expenses
Specialist
6. 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
epo
ee schedule
Preauthorization
(DME) Durable Medical Equipment
7. 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
(Non-par) Non-Participating Provider
(POS) Point-of Service Plan
attending physician
ethics
8. The dates of healthcare services were provided to the beneficiary
(AOB) Assignment of Benefits
Privileged information
state preemption
(DOS) Date of Service
9. 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
(ERISA) Employee Retirement Income Security Act of 1974
fraud
open panel HMO
(DME) Durable Medical Equipment
10. 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
pcp
Preauthorization
deductible
11. 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
Open Enrollment
hmo
abuse
Pre-existing Condition Exclusion
12. The condition of being secluded from the presence or view of others.
privacy
Pre-existing Condition Exclusion
(DME) Durable Medical Equipment
Maximum Out Of Pocket
13. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
prepaid plan
Open Enrollment
(OOPs) Out of Pocket Costs/Expenses
14. 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.
ethics
Privacy officer
(DRG's)
Protected health information
15. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
premium
pos
Referral
16. 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
(TPA) Third Party Administrator
AMA
covered entity
e-health information management
17. A rule - condition - or requirement
Allowed Expenses
Notice of Privacy Practices
Standard
(DOS) Date of Service
18. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Assignment & Authorization
(APC) Ambulatory Patient Classifications
Resonable Charge
complience plan
19. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
closed panel HMO
Specialist
e-health information management
IIHI
20. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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21. 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
self-referral
Sub-acute Care
electronic media
22. Billing for services not performed
referral
phantom billing
(ERISA) Employee Retirement Income Security Act of 1974
(DME) Durable Medical Equipment
23. Medical staff member who is legally responsible for the care and treatment given to a patient.
business associate
attending physician
self-referral
preauthorization
24. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(DOS) Date of Service
(DCI) Duplicate Coverage Inquiry
(OOPs) Out of Pocket Costs/Expenses
Subscriber
25. 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
closed panel HMO
covered entity
breach of confidential communication
(POS) Point-of Service Plan
26. Is a provider who sends the patients for testing or treatment
referring physician
Amblatory Care
(ABN) Advance Beneficiary Notice
Deductible
27. An organization of provider sites with a contracted relationship that offer services
e-health information management
open panel HMO
ids
etiquette
28. 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
complience
benefit period
IIHI
Supplementary Medical Insurance
29. 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
(APC) Ambulatory Patient Classifications
pcp
Deductible
phantom billing
30. 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
(POS) Point-of Service Plan
(PCP) Primary Care Physician
claim
(UCR) Usual - Customary and Reasonable
31. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Network
(DCI) Duplicate Coverage Inquiry
claim
HIPAA
32. American Medical Association
state preemption
consulting physician
AMA
(POS) Point-of Service Plan
33. 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.
(OOPs) Out of Pocket Costs/Expenses
(DME) Durable Medical Equipment
confidentiality
health care provider
34. 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)
IIHI
(PCP) Primary Care Physician
Participating Provider
35. 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
breach of confidential communication
covered entity
(PEC) Pre-existing condition
36. 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
Open Enrollment
ids
phantom billing
Standard
37. 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
complience
deductible
ppo
38. 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.
Referral
prepaid plan
Privileged information
business associate
39. Billing for services not performed
(PPS) Hospital Impatient Prospective Payment System
phantom billing
referral
preauthorization
40. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Allowed Expenses
Protected health information
(APC) Ambulatory Patient Classifications
pcp
41. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Coordinated Coverage
ids
covered entity
42. Customs - rules of conduct - courtesy - and manners of the medical profession
(DRG's)
etiquette
Allowed Expenses
electronic media
43. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Notice of Privacy Practices
HIPAA
e-health information management
confidentiality
44. 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
(ABN) Advance Beneficiary Notice
IIHI
privacy
45. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
breach of confidential communication
ordering physician
open panel HMO
authorization form
46. Is the provider who renders a service to a patient
Treating or performing physician
Standard
Participating Provider
deductible
47. Is a provider who sends the patients for testing or treatment
open panel HMO
security officer
Protected health information
referring physician
48. Medical services provided on an outpatient basis
AMA
pos
Referral
Amblatory Care
49. 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
econdary Payer
Claim
Amblatory Care
ppo
50. 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
HIPAA
Open Enrollment
(AOB) Assignment of Benefits
(TPA) Third Party Administrator