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Test your basic knowledge |
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. A list of the amount to be paid by an insurance company for each procedure service
consent
AMA
ee schedule
(PEC) Pre-existing condition
2. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
(TPA) Third Party Administrator
Protected health information
electronic media
3. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
security officer
(TPA) Third Party Administrator
IIHI
4. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Security Rule
nonprivileged information
pcp
confidentiality
5. 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
Assignment & Authorization
Pre-certification
(UR) Utilization review
subscriber
6. A clinic that is owned by the HMO and the physicians are employees of the HMO
(PPS) Hospital Impatient Prospective Payment System
medical foundation
premium
closed panel HMO
7. 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
Confidential communication
preauthorization
IIHI
8. 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
Beneficiary
HIPAA
Preauthorization
(DCI) Duplicate Coverage Inquiry
9. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Privileged information
Referral
Privacy officer
econdary Payer
10. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
attending physician
Out of Network (OON)
premium
11. 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
prepaid plan
ee schedule
preauthorization
Deductible
12. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
Supplementary Medical Insurance
Open Enrollment
complience plan
13. A nonprofit integrated delivery system
(UR) Utilization review
Claim
crossover claim
medical foundation
14. 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
covered entity
Preauthorization
Individually identifiable health information
benefit period
15. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
ee schedule
subscriber
econdary Payer
Security Rule
16. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
Treating or performing physician
(DME) Durable Medical Equipment
Pre-certification
17. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PCN) Primary Care Network
Participating Provider
transaction
Assignment & Authorization
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
ordering physician
disclosure
(COBRA)
Resonable Charge
19. 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
security officer
preauthorization
Pre-existing Condition Exclusion
20. 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
Network
ppo
(PPS) Hospital Impatient Prospective Payment System
(ABN) Advance Beneficiary Notice
21. Billing for services not performed
(PCP) Primary Care Physician
abuse
phantom billing
Medigap Insurance
22. 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.
AMA
etiquette
business associate
(DCI) Duplicate Coverage Inquiry
23. The dates of healthcare services were provided to the beneficiary
(DME) Durable Medical Equipment
(DOS) Date of Service
complience
IIHI
24. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
(PCP) Primary Care Physician
Consent form
business associate
25. 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.
(PPS) Hospital Impatient Prospective Payment System
Deductible
nonprivileged information
security officer
26. A review of the need for inpatient hospital care - completed before the actual admission
Specialist
consent
(PAC) Pre- Admission Certification
Pre-existing Condition Exclusion
27. 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
Covered Expenses
Privileged information
pos
(ABN) Advance Beneficiary Notice
28. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
premium
breach of confidential communication
Network
Medigap Insurance
29. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
claim
(COB) Coordination of Benefits
Resonable Charge
30. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
epo
consent
(UR) Utilization review
Treating or performing physician
31. Billing for services not performed
referral
transaction
Coordinated Coverage
phantom billing
32. Is a provider who sends the patients for testing or treatment
Security Rule
ordering physician
referring physician
Privacy officer
33. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Individually identifiable health information
(PEC) Pre-existing condition
claim
34. 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
e-health information management
covered entity
econdary Payer
Consent form
35. 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
Privacy officer
health care provider
Sub-acute Care
Experimental Procedures
36. 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
ids
(DCI) Duplicate Coverage Inquiry
econdary Payer
epo
37. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
transaction
(DCI) Duplicate Coverage Inquiry
cash flow
Embezzlement
38. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Resonable Charge
(TPA) Third Party Administrator
consulting physician
prepaid plan
39. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
(PPS) Hospital Impatient Prospective Payment System
referring physician
covered entity
Privileged information
40. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Supplementary Medical Insurance
phantom billing
pcp
closed panel HMO
41. 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
closed panel HMO
Open Enrollment
(PEC) Pre-existing condition
clearinghouse
42. A willful act by an employee of taking possession of an employer's money
Embezzlement
etiquette
claim
econdary Payer
43. 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
Pre-existing Condition Exclusion
(DCI) Duplicate Coverage Inquiry
Network
deductible
44. What the insurance company will consider paying for as defined in the contract.
Amblatory Care
etiquette
Covered Expenses
econdary Payer
45. 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
Supplementary Medical Insurance
pos
Security Rule
phantom billing
46. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Participating Provider
Specialist
clearinghouse
Standard
47. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Sub-acute Care
disclosure
e-health information management
consent
48. 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.
Referral
Notice of Privacy Practices
consent
Resonable Charge
49. 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
Individually identifiable health information
(ERISA) Employee Retirement Income Security Act of 1974
Allowed Expenses
benefit period
50. 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
disclosure
authorization form
Out of Network (OON)
Out of Network (OON)
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