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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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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. 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.
epo
electronic media
state preemption
(EPO) Exclusive Provider Organization
2. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(PPS) Hospital Impatient Prospective Payment System
Sub-acute Care
ordering physician
business associate
3. 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
Pre-existing Condition Exclusion
authorization form
clearinghouse
(PCP) Primary Care Physician
4. 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.
Referral
(COBRA)
Treating or performing physician
health care provider
5. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
confidentiality
consulting physician
(PCP) Primary Care Physician
6. Health Information Portability and Accountability Act
HIPAA
Confidential communication
IIHI
Sub-acute Care
7. 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
(DME) Durable Medical Equipment
Medigap Insurance
Assignment & Authorization
(UCR) Usual - Customary and Reasonable
8. Verbal or written agreement that gives approval to some action - situation - or statement.
disclosure
confidentiality
Allowed Expenses
consent
9. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
hmo
subscriber
pos
Notice of Privacy Practices
10. 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
(PCN) Primary Care Network
(ABN) Advance Beneficiary Notice
(TPA) Third Party Administrator
(DCI) Duplicate Coverage Inquiry
11. 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
Out of Network (OON)
(EPO) Exclusive Provider Organization
Confidential communication
Allowed Expenses
12. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(ERISA) Employee Retirement Income Security Act of 1974
premium
(PEC) Pre-existing condition
(ERISA) Employee Retirement Income Security Act of 1974
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
(DME) Durable Medical Equipment
Consent form
Open Enrollment
Assignment & Authorization
14. Individually identifiable health information
Experimental Procedures
IIHI
(PAC) Pre- Admission Certification
Out of Network (OON)
15. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
(PPS) Hospital Impatient Prospective Payment System
Network
self-referral
16. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
closed panel HMO
cash flow
clearinghouse
(Non-par) Non-Participating Provider
17. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(POS) Point-of Service Plan
(DOS) Date of Service
complience
Referral
18. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
consent
(PAC) Pre- Admission Certification
abuse
(OOPs) Out of Pocket Costs/Expenses
19. Standards of conduct generally accepted as a moral guide for behavior.
Security Rule
Supplementary Medical Insurance
ethics
econdary Payer
20. 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
pos
e-health information management
prepaid plan
Pre-existing Condition Exclusion
21. An organization of provider sites with a contracted relationship that offer services
Standard
referral
ids
(APC) Ambulatory Patient Classifications
22. Approval or consent by a primary physician for patient referral to ancillary services and specialists
pcp
ids
Referral
state preemption
23. 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
attending physician
(DCI) Duplicate Coverage Inquiry
(COBRA)
(DME) Durable Medical Equipment
24. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
(ERISA) Employee Retirement Income Security Act of 1974
privacy
(DCI) Duplicate Coverage Inquiry
25. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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26. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Confidential communication
preauthorization
breach of confidential communication
Medigap Insurance
27. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
closed panel HMO
abuse
Experimental Procedures
ethics
28. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare
Allowed Expenses
(Non-par) Non-Participating Provider
covered entity
complience
29. 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
transaction
Experimental Procedures
Pre-certification
subscriber
30. A rule - condition - or requirement
Supplementary Medical Insurance
(COBRA)
disclosure
Standard
31. The condition of being secluded from the presence or view of others.
econdary Payer
privacy
Resonable Charge
authorization form
32. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
cash flow
(APC) Ambulatory Patient Classifications
(EPO) Exclusive Provider Organization
Medigap Insurance
33. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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34. A rule - condition - or requirement
closed panel HMO
Deductible
Standard
(Non-par) Non-Participating Provider
35. Medicare's method of paying acute care hospitals for inpatient care
Allowed Expenses
hmo
(UR) Utilization review
(PPS) Hospital Impatient Prospective Payment System
36. Unauthorized release of information
consent
breach of confidential communication
Network
confidentiality
37. A monthly fee paid by the insured for specific medical insurance coverage
Security Rule
self-referral
Subscriber
premium
38. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
crossover claim
Notice of Privacy Practices
(OOPs) Out of Pocket Costs/Expenses
39. Billing for services not performed
phantom billing
fraud
referring physician
Pre-existing Condition Exclusion
40. 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
pcp
Assignment & Authorization
state preemption
41. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
epo
(PCP) Primary Care Physician
IIHI
42. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
ethics
ordering physician
business associate
43. The period of time that payment for Medicare inpatient hospital benefits are available
(EPO) Exclusive Provider Organization
benefit period
crossover claim
subscriber
44. 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
Claim
(TPA) Third Party Administrator
(ERISA) Employee Retirement Income Security Act of 1974
HIPAA
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
Participating Provider
Embezzlement
pos
(DRG's)
46. 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
health care provider
attending physician
(ABN) Advance Beneficiary Notice
Deductible
47. 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
cash flow
Protected health information
(TPA) Third Party Administrator
(DME) Durable Medical Equipment
48. 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
(PCN) Primary Care Network
Assignment & Authorization
HIPAA
ee schedule
49. Medical services provided on an outpatient basis
security officer
Privacy officer
Amblatory Care
(UR) Utilization review
50. Is a provider who sends the patients for testing or treatment
Open Enrollment
Out of Network (OON)
IIHI
referring physician