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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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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 intentional misrepresentation of the facts to deceive or mislead another.
Allowed Expenses
pos
fraud
referring physician
2. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Individually identifiable health information
(ERISA) Employee Retirement Income Security Act of 1974
(APC) Ambulatory Patient Classifications
pcp
3. 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
abuse
(DOS) Date of Service
(UR) Utilization review
(PCP) Primary Care Physician
4. 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
referring physician
referring physician
privacy
prepaid plan
5. 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
Standard
(UR) Utilization review
authorization form
(PAC) Pre- Admission Certification
6. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Coordinated Coverage
Amblatory Care
claim
ids
7. 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
preauthorization
(APC) Ambulatory Patient Classifications
Out of Network (OON)
open panel HMO
8. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
electronic media
Sub-acute Care
(UR) Utilization review
(DCI) Duplicate Coverage Inquiry
9. 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.
self-referral
Protected health information
(DOS) Date of Service
medical foundation
10. Medical services provided on an outpatient basis
Amblatory Care
fraud
(ABN) Advance Beneficiary Notice
(TPA) Third Party Administrator
11. A rule - condition - or requirement
Standard
transaction
confidentiality
(DME) Durable Medical Equipment
12. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
complience plan
preauthorization
crossover claim
e-health information management
13. 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.
Notice of Privacy Practices
deductible
(UR) Utilization review
state preemption
14. 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.
self-referral
epo
phantom billing
Privacy officer
15. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Treating or performing physician
ethics
Experimental Procedures
16. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Protected health information
covered entity
Pre-certification
17. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
AMA
Claim
preauthorization
Deductible
18. 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
phantom billing
(PCN) Primary Care Network
confidentiality
open panel HMO
19. Customs - rules of conduct - courtesy - and manners of the medical profession
pcp
referral
security officer
etiquette
20. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
etiquette
claim
(DCI) Duplicate Coverage Inquiry
(UR) Utilization review
21. 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.
preauthorization
Protected health information
confidentiality
(PAC) Pre- Admission Certification
22. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
deductible
(Non-par) Non-Participating Provider
hmo
23. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Out of Network (OON)
premium
Supplementary Medical Insurance
24. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Referral
preauthorization
subscriber
(UCR) Usual - Customary and Reasonable
25. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
pcp
Amblatory Care
Individually identifiable health information
26. 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.
electronic media
abuse
Privacy officer
complience plan
27. A willful act by an employee of taking possession of an employer's money
Embezzlement
consent
Security Rule
Experimental Procedures
28. A review of the need for inpatient hospital care - completed before the actual admission
(DCI) Duplicate Coverage Inquiry
(PPS) Hospital Impatient Prospective Payment System
(UR) Utilization review
(PAC) Pre- Admission Certification
29. Integrating benefits payable under more than one health insurance.
(DME) Durable Medical Equipment
Coordinated Coverage
attending physician
(APC) Ambulatory Patient Classifications
30. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
Sub-acute Care
ordering physician
Pre-existing Condition Exclusion
31. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Supplementary Medical Insurance
Experimental Procedures
(PCP) Primary Care Physician
32. American Medical Association
Protected health information
AMA
referral
Coordinated Coverage
33. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Allowed Expenses
Deductible
(EPO) Exclusive Provider Organization
(DRG's)
34. Medical services provided on an outpatient basis
Amblatory Care
covered entity
Consent form
premium
35. 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
Subscriber
(PCP) Primary Care Physician
referring physician
attending physician
36. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Pre-certification
Open Enrollment
Referral
IIHI
37. 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
Pre-certification
Consent form
pos
(POS) Point-of Service Plan
38. A monthly fee paid by the insured for specific medical insurance coverage
Covered Expenses
nonprivileged information
ppo
premium
39. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
Open Enrollment
business associate
clearinghouse
40. 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
Privileged information
Experimental Procedures
ppo
deductible
41. 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
claim
ppo
Privacy officer
42. 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
consulting physician
prepaid plan
disclosure
open panel HMO
43. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Sub-acute Care
subscriber
clearinghouse
IIHI
44. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
referring physician
Experimental Procedures
(PPS) Hospital Impatient Prospective Payment System
electronic media
45. Is a provider who sends the patients for testing or treatment
Experimental Procedures
referring physician
Maximum Out Of Pocket
e-health information management
46. Unauthorized release of information
Assignment & Authorization
Individually identifiable health information
breach of confidential communication
transaction
47. Medicare's method of paying acute care hospitals for inpatient care
crossover claim
Deductible
Open Enrollment
(PPS) Hospital Impatient Prospective Payment System
48. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment
(DME) Durable Medical Equipment
Embezzlement
Medigap Insurance
AMA
49. 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
phantom billing
transaction
(DOS) Date of Service
Preauthorization
50. Someone who is eligible for or receiving benefits under an insurance policy or plan
(PCP) Primary Care Physician
(ERISA) Employee Retirement Income Security Act of 1974
Beneficiary
business associate
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