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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
Preauthorization
Assignment & Authorization
(PPS) Hospital Impatient Prospective Payment System
referral
2. 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
phantom billing
Coordinated Coverage
abuse
3. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Pre-existing Condition Exclusion
Resonable Charge
subscriber
breach of confidential communication
4. 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
crossover claim
Consent form
Sub-acute Care
e-health information management
5. Verbal or written agreement that gives approval to some action - situation - or statement.
Out of Network (OON)
(EPO) Exclusive Provider Organization
clearinghouse
consent
6. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(DME) Durable Medical Equipment
confidentiality
Referral
security officer
7. Health Information Portability and Accountability Act
Consent form
HIPAA
Coordinated Coverage
(UR) Utilization review
8. 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.
Protected health information
Subscriber
Amblatory Care
Beneficiary
9. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
business associate
self-referral
Amblatory Care
(TPA) Third Party Administrator
10. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
Notice of Privacy Practices
Standard
referral
11. Integrating benefits payable under more than one health insurance.
ppo
Coordinated Coverage
Network
referring physician
12. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
(PEC) Pre-existing condition
confidentiality
benefit period
13. An intentional misrepresentation of the facts to deceive or mislead another.
(PPS) Hospital Impatient Prospective Payment System
fraud
self-referral
Confidential communication
14. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
premium
preauthorization
Experimental Procedures
15. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Deductible
Consent form
Preauthorization
16. A clinic that is owned by the HMO and the physicians are employees of the HMO
medical foundation
(PAC) Pre- Admission Certification
closed panel HMO
Covered Expenses
17. The dates of healthcare services were provided to the beneficiary
referring physician
complience plan
(DOS) Date of Service
consent
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
fraud
Pre-existing Condition Exclusion
(PAC) Pre- Admission Certification
(PEC) Pre-existing condition
19. A nonprofit integrated delivery system
Coordinated Coverage
Consent form
medical foundation
confidentiality
20. 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
privacy
Security Rule
complience
transaction
21. 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.
Covered Expenses
health care provider
complience plan
(DRG's)
22. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(ABN) Advance Beneficiary Notice
closed panel HMO
ee schedule
(UCR) Usual - Customary and Reasonable
23. A privileged communication that may be disclosed only with the patient's permission.
HIPAA
Subscriber
(DOS) Date of Service
Confidential communication
24. 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
privacy
(ABN) Advance Beneficiary Notice
consulting physician
Supplementary Medical Insurance
25. 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.
security officer
health care provider
state preemption
(COBRA)
26. 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
Assignment & Authorization
Medigap Insurance
subscriber
(POS) Point-of Service Plan
27. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
health care provider
Network
ordering physician
subscriber
28. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
(APC) Ambulatory Patient Classifications
(PCP) Primary Care Physician
(DRG's)
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
ethics
Deductible
confidentiality
self-referral
30. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
breach of confidential communication
(COB) Coordination of Benefits
(DRG's)
hmo
31. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Referral
Medigap Insurance
Beneficiary
Resonable Charge
32. 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
Confidential communication
security officer
(COBRA)
Assignment & Authorization
33. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Treating or performing physician
Participating Provider
deductible
34. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
HIPAA
Subscriber
Resonable Charge
premium
35. 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
ids
Security Rule
ppo
36. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
referring physician
covered entity
business associate
Network
37. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
authorization form
Resonable Charge
Participating Provider
complience
38. A structure for classifying outpatient services and procedures for purpose of payment
Open Enrollment
(APC) Ambulatory Patient Classifications
(COB) Coordination of Benefits
transaction
39. 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
Claim
phantom billing
electronic media
Pre-existing Condition Exclusion
40. 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
Beneficiary
(Non-par) Non-Participating Provider
open panel HMO
attending physician
41. Medical services provided on an outpatient basis
Claim
cash flow
Security Rule
Amblatory Care
42. 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
(TPA) Third Party Administrator
Coordinated Coverage
(DOS) Date of Service
prepaid plan
43. Someone who is eligible for or receiving benefits under an insurance policy or plan
epo
Specialist
Deductible
Beneficiary
44. A willful act by an employee of taking possession of an employer's money
health care provider
Embezzlement
preauthorization
(COBRA)
45. 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
etiquette
Covered Expenses
(ABN) Advance Beneficiary Notice
AMA
46. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
(AOB) Assignment of Benefits
phantom billing
Security Rule
47. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
preauthorization
abuse
Notice of Privacy Practices
(UCR) Usual - Customary and Reasonable
48. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(APC) Ambulatory Patient Classifications
fraud
(PPS) Hospital Impatient Prospective Payment System
Resonable Charge
49. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Deductible
complience
electronic media
pos
50. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(PPS) Hospital Impatient Prospective Payment System
pcp
self-referral
Protected health information