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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. 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
(UR) Utilization review
Medigap Insurance
hmo
2. 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
authorization form
Protected health information
HIPAA
Pre-certification
3. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
pcp
(AOB) Assignment of Benefits
Medigap Insurance
Individually identifiable health information
4. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
ppo
cash flow
(PCP) Primary Care Physician
Medigap Insurance
5. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Pre-existing Condition Exclusion
Treating or performing physician
AMA
clearinghouse
6. 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
cash flow
(PCP) Primary Care Physician
e-health information management
Notice of Privacy Practices
7. Is a provider who sends the patients for testing or treatment
referring physician
preauthorization
security officer
Deductible
8. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
premium
phantom billing
deductible
open panel HMO
9. 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
Participating Provider
claim
complience
etiquette
10. Medical services provided on an outpatient basis
abuse
(TPA) Third Party Administrator
security officer
Amblatory Care
11. 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
ppo
Network
transaction
HIPAA
12. 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
Preauthorization
complience plan
epo
Sub-acute Care
13. Verbal or written agreement that gives approval to some action - situation - or statement.
nonprivileged information
cash flow
(Non-par) Non-Participating Provider
consent
14. 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
(POS) Point-of Service Plan
(PAC) Pre- Admission Certification
abuse
Claim
15. The dates of healthcare services were provided to the beneficiary
(UR) Utilization review
(DME) Durable Medical Equipment
(DOS) Date of Service
hmo
16. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
fraud
Allowed Expenses
e-health information management
ordering physician
17. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
Protected health information
Referral
Coordinated Coverage
Maximum Out Of Pocket
18. 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
(PCP) Primary Care Physician
(DOS) Date of Service
(PAC) Pre- Admission Certification
attending physician
19. Standards of conduct generally accepted as a moral guide for behavior.
Out of Network (OON)
Coordinated Coverage
ethics
etiquette
20. 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
covered entity
(ERISA) Employee Retirement Income Security Act of 1974
(Non-par) Non-Participating Provider
referring physician
21. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
breach of confidential communication
(UCR) Usual - Customary and Reasonable
(Non-par) Non-Participating Provider
IIHI
22. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
pos
Assignment & Authorization
complience
crossover claim
23. An organization of provider sites with a contracted relationship that offer services
Coordinated Coverage
ordering physician
ids
(Non-par) Non-Participating Provider
24. 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
ee schedule
(ERISA) Employee Retirement Income Security Act of 1974
(PCP) Primary Care Physician
pcp
25. The period of time that payment for Medicare inpatient hospital benefits are available
Resonable Charge
disclosure
crossover claim
benefit period
26. 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
(DCI) Duplicate Coverage Inquiry
Protected health information
Out of Network (OON)
consulting physician
27. 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
Assignment & Authorization
Notice of Privacy Practices
(EPO) Exclusive Provider Organization
28. A monthly fee paid by the insured for specific medical insurance coverage
(COB) Coordination of Benefits
premium
Open Enrollment
pcp
29. A nonprofit integrated delivery system
abuse
(DRG's)
pos
medical foundation
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
(PAC) Pre- Admission Certification
hmo
attending physician
closed panel HMO
31. 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
Resonable Charge
(DRG's)
ids
econdary Payer
32. 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 entity
Subscriber
consulting physician
pos
33. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
(EPO) Exclusive Provider Organization
Notice of Privacy Practices
Allowed Expenses
34. 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.
Privileged information
(AOB) Assignment of Benefits
(DOS) Date of Service
Coordinated Coverage
35. 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
(PEC) Pre-existing condition
Open Enrollment
(AOB) Assignment of Benefits
36. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Protected health information
abuse
Experimental Procedures
(EPO) Exclusive Provider Organization
37. 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) Primary Care Physician
Treating or performing physician
consent
38. Is the provider who renders a service to a patient
(ABN) Advance Beneficiary Notice
preauthorization
Standard
Treating or performing physician
39. A review of the need for inpatient hospital care - completed before the actual admission
privacy
Assignment & Authorization
Open Enrollment
(PAC) Pre- Admission Certification
40. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Open Enrollment
preauthorization
Participating Provider
41. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(ABN) Advance Beneficiary Notice
disclosure
Pre-existing Condition Exclusion
(OOPs) Out of Pocket Costs/Expenses
42. 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.
Pre-existing Condition Exclusion
(TPA) Third Party Administrator
(AOB) Assignment of Benefits
Protected health information
43. 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.
etiquette
Deductible
state preemption
(DRG's)
44. A privileged communication that may be disclosed only with the patient's permission.
(Non-par) Non-Participating Provider
Confidential communication
(ABN) Advance Beneficiary Notice
AMA
45. 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
self-referral
Sub-acute Care
referring physician
Out of Network (OON)
46. 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.
(UR) Utilization review
Privacy officer
hmo
(DRG's)
47. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Security Rule
(DCI) Duplicate Coverage Inquiry
Protected health information
Network
48. Verbal or written agreement that gives approval to some action - situation - or statement.
Confidential communication
Confidential communication
consent
self-referral
49. 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.
subscriber
health care provider
(DCI) Duplicate Coverage Inquiry
Security Rule
50. The dates of healthcare services were provided to the beneficiary
(ERISA) Employee Retirement Income Security Act of 1974
(DOS) Date of Service
Preauthorization
nonprivileged information