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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Study First
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. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
Embezzlement
hmo
Notice of Privacy Practices
2. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
clearinghouse
abuse
Referral
(EPO) Exclusive Provider Organization
3. 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.
Covered Expenses
Notice of Privacy Practices
open panel HMO
cash flow
4. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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5. American Medical Association
ee schedule
AMA
HIPAA
consent
6. 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
(COB) Coordination of Benefits
complience plan
medical foundation
7. What the insurance company will consider paying for as defined in the contract.
Amblatory Care
Covered Expenses
(POS) Point-of Service Plan
Notice of Privacy Practices
8. 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
(TPA) Third Party Administrator
(ERISA) Employee Retirement Income Security Act of 1974
electronic media
etiquette
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
(TPA) Third Party Administrator
Consent form
complience plan
10. Approval or consent by a primary physician for patient referral to ancillary services and specialists
open panel HMO
prepaid plan
(PAC) Pre- Admission Certification
Referral
11. A review of the need for inpatient hospital care - completed before the actual admission
prepaid plan
(APC) Ambulatory Patient Classifications
(PAC) Pre- Admission Certification
hmo
12. 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
IIHI
claim
econdary Payer
(DME) Durable Medical Equipment
13. 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
health care provider
privacy
(PEC) Pre-existing condition
14. Individually identifiable health information
IIHI
Allowed Expenses
security officer
covered entity
15. A provision that apples when a person is covered under more than one group medical program
Specialist
health care provider
Maximum Out Of Pocket
(COB) Coordination of Benefits
16. Unauthorized release of information
ids
crossover claim
breach of confidential communication
(COBRA)
17. 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
Assignment & Authorization
Allowed Expenses
covered entity
etiquette
18. 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
Consent form
disclosure
ppo
Allowed Expenses
19. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(COB) Coordination of Benefits
AMA
(DOS) Date of Service
e-health information management
20. 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
phantom billing
hmo
Resonable Charge
21. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
ordering physician
authorization form
Preauthorization
(EPO) Exclusive Provider Organization
22. What the insurance company will consider paying for as defined in the contract.
(COB) Coordination of Benefits
Covered Expenses
(DOS) Date of Service
Subscriber
23. 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
pos
cash flow
24. 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
crossover claim
(OOPs) Out of Pocket Costs/Expenses
health care provider
Out of Network (OON)
25. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
crossover claim
(DOS) Date of Service
clearinghouse
(UCR) Usual - Customary and Reasonable
26. Is a provider who sends the patients for testing or treatment
pcp
referring physician
Confidential communication
Preauthorization
27. A privileged communication that may be disclosed only with the patient's permission.
ppo
deductible
consent
Confidential communication
28. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Deductible
referring physician
health care provider
29. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
cash flow
medical foundation
security officer
30. 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
epo
(UR) Utilization review
Sub-acute Care
transaction
31. 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.
Privacy officer
deductible
Supplementary Medical Insurance
preauthorization
32. 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.
(Non-par) Non-Participating Provider
Notice of Privacy Practices
Privileged information
health care provider
33. A willful act by an employee of taking possession of an employer's money
Embezzlement
Amblatory Care
(UCR) Usual - Customary and Reasonable
privacy
34. 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
confidentiality
Supplementary Medical Insurance
security officer
Privacy officer
35. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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36. A structure for classifying outpatient services and procedures for purpose of payment
fraud
closed panel HMO
(APC) Ambulatory Patient Classifications
Pre-existing Condition Exclusion
37. 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
security officer
Participating Provider
state preemption
referring physician
38. A patient claim is eligible for medicare and medicaid
Participating Provider
crossover claim
ppo
(AOB) Assignment of Benefits
39. 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
confidentiality
business associate
(ABN) Advance Beneficiary Notice
Confidential communication
40. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Coordinated Coverage
electronic media
complience plan
Beneficiary
41. 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.
preauthorization
self-referral
state preemption
transaction
42. 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
covered entity
consulting physician
(UR) Utilization review
43. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
pos
(UCR) Usual - Customary and Reasonable
(PAC) Pre- Admission Certification
transaction
44. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
ids
Coordinated Coverage
ppo
45. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
IIHI
epo
hmo
(UR) Utilization review
46. A health insurance enrollee chooses to see an out of network provider without authorization
e-health information management
Treating or performing physician
Notice of Privacy Practices
self-referral
47. Is a provider who sends the patients for testing or treatment
Claim
HIPAA
referring physician
Privileged information
48. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Embezzlement
Amblatory Care
deductible
complience
49. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
medical foundation
Embezzlement
(OOPs) Out of Pocket Costs/Expenses
Protected health information
50. 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
Pre-existing Condition Exclusion
Pre-certification
hmo