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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. 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
authorization form
Privacy officer
Preauthorization
AMA
2. 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
Experimental Procedures
self-referral
electronic media
Participating Provider
3. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Medigap Insurance
Network
ethics
Protected health information
4. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Pre-existing Condition Exclusion
Assignment & Authorization
Specialist
Beneficiary
5. 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.
Pre-certification
Treating or performing physician
(PCN) Primary Care Network
Privacy officer
6. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
referral
(UCR) Usual - Customary and Reasonable
(ERISA) Employee Retirement Income Security Act of 1974
security officer
7. Is a provider who sends the patients for testing or treatment
(COBRA)
(UR) Utilization review
prepaid plan
referring physician
8. A patient claim is eligible for medicare and medicaid
Assignment & Authorization
crossover claim
Amblatory Care
complience
9. The amount of actual money available to the medical practice
crossover claim
(DOS) Date of Service
premium
cash flow
10. 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
(DME) Durable Medical Equipment
Pre-existing Condition Exclusion
Out of Network (OON)
abuse
11. Individually identifiable health information
Amblatory Care
privacy
IIHI
(Non-par) Non-Participating Provider
12. 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
complience
Subscriber
clearinghouse
econdary Payer
13. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
Assignment & Authorization
Experimental Procedures
Embezzlement
Open Enrollment
14. A provision that apples when a person is covered under more than one group medical program
covered entity
Referral
(COB) Coordination of Benefits
Supplementary Medical Insurance
15. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
(PPS) Hospital Impatient Prospective Payment System
phantom billing
Standard
16. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Treating or performing physician
(APC) Ambulatory Patient Classifications
Claim
(ABN) Advance Beneficiary Notice
17. 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
crossover claim
(PPS) Hospital Impatient Prospective Payment System
medical foundation
(PCN) Primary Care Network
18. Unauthorized release of information
(COBRA)
Embezzlement
breach of confidential communication
Specialist
19. Approval or consent by a primary physician for patient referral to ancillary services and specialists
medical foundation
Standard
Referral
phantom billing
20. 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
phantom billing
Network
Open Enrollment
(PCN) Primary Care Network
21. 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
(PAC) Pre- Admission Certification
Preauthorization
Amblatory Care
ids
22. Is a provider who sends the patients for testing or treatment
referring physician
ee schedule
medical foundation
crossover claim
23. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
claim
subscriber
Open Enrollment
Embezzlement
24. 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
Participating Provider
Out of Network (OON)
complience
nonprivileged information
25. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
(POS) Point-of Service Plan
security officer
(ERISA) Employee Retirement Income Security Act of 1974
26. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
transaction
security officer
(PEC) Pre-existing condition
27. A rule - condition - or requirement
breach of confidential communication
Pre-existing Condition Exclusion
Standard
referring physician
28. 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
Open Enrollment
(PCN) Primary Care Network
Preauthorization
Pre-certification
29. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.
Covered Expenses
Maximum Out Of Pocket
health care provider
security officer
30. 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.
Pre-certification
e-health information management
nonprivileged information
Protected health information
31. Someone who is eligible for or receiving benefits under an insurance policy or plan
Notice of Privacy Practices
Beneficiary
Embezzlement
(AOB) Assignment of Benefits
32. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
covered entity
(ABN) Advance Beneficiary Notice
Network
(POS) Point-of Service Plan
33. A structure for classifying outpatient services and procedures for purpose of payment
Covered Expenses
(APC) Ambulatory Patient Classifications
abuse
Security Rule
34. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
Pre-existing Condition Exclusion
Participating Provider
complience plan
35. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
preauthorization
pcp
referral
subscriber
36. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(COB) Coordination of Benefits
consulting physician
Privileged information
37. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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38. The condition of being secluded from the presence or view of others.
epo
(COB) Coordination of Benefits
prepaid plan
privacy
39. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Experimental Procedures
Claim
(POS) Point-of Service Plan
40. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Privileged information
clearinghouse
Beneficiary
41. 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
(EPO) Exclusive Provider Organization
business associate
deductible
42. 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
(DRG's)
(COBRA)
epo
clearinghouse
43. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
epo
referring physician
claim
44. 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
(COBRA)
Maximum Out Of Pocket
prepaid plan
preauthorization
45. 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
epo
disclosure
AMA
46. A willful act by an employee of taking possession of an employer's money
ethics
breach of confidential communication
Embezzlement
prepaid plan
47. 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
(EPO) Exclusive Provider Organization
health care provider
security officer
48. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Open Enrollment
(APC) Ambulatory Patient Classifications
(TPA) Third Party Administrator
ordering physician
49. 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
IIHI
authorization form
ethics
premium
50. 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
authorization form
Beneficiary
Pre-certification
(AOB) Assignment of Benefits