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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.
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. A willful act by an employee of taking possession of an employer's money
ethics
Embezzlement
benefit period
(AOB) Assignment of Benefits
2. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(DME) Durable Medical Equipment
(UR) Utilization review
Referral
Covered Expenses
3. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Pre-certification
disclosure
Standard
complience plan
4. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Covered Expenses
ids
Preauthorization
claim
5. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
etiquette
econdary Payer
(PCN) Primary Care Network
6. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
covered entity
premium
referral
Security Rule
7. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured
Embezzlement
breach of confidential communication
confidentiality
(AOB) Assignment of Benefits
8. The condition of being secluded from the presence or view of others.
breach of confidential communication
Out of Network (OON)
health care provider
privacy
9. Billing for services not performed
complience
Individually identifiable health information
e-health information management
phantom billing
10. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
closed panel HMO
consulting physician
Allowed Expenses
subscriber
11. 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
fraud
(ABN) Advance Beneficiary Notice
Embezzlement
12. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Preauthorization
Supplementary Medical Insurance
Resonable Charge
Individually identifiable health information
13. 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
(EPO) Exclusive Provider Organization
Referral
premium
14. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
authorization form
(PEC) Pre-existing condition
Subscriber
15. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
ordering physician
preauthorization
Consent form
16. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Notice of Privacy Practices
(Non-par) Non-Participating Provider
transaction
Privacy officer
17. 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
referring physician
Consent form
(PCN) Primary Care Network
18. 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
hmo
Experimental Procedures
(POS) Point-of Service Plan
(AOB) Assignment of Benefits
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
Network
hmo
Deductible
(PEC) Pre-existing condition
20. Medical staff member who is legally responsible for the care and treatment given to a patient.
electronic media
premium
attending physician
(Non-par) Non-Participating Provider
21. A review of the need for inpatient hospital care - completed before the actual admission
(AOB) Assignment of Benefits
(PAC) Pre- Admission Certification
crossover claim
Confidential communication
22. 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
Network
Participating Provider
Allowed Expenses
transaction
23. 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.
Deductible
(PAC) Pre- Admission Certification
subscriber
Privacy officer
24. 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
(Non-par) Non-Participating Provider
(APC) Ambulatory Patient Classifications
(ABN) Advance Beneficiary Notice
breach of confidential communication
25. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Notice of Privacy Practices
preauthorization
attending physician
medical foundation
26. 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
e-health information management
Confidential communication
Network
27. A patient claim is eligible for medicare and medicaid
Covered Expenses
crossover claim
Protected health information
etiquette
28. 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
disclosure
Embezzlement
(POS) Point-of Service Plan
29. 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.
covered entity
state preemption
confidentiality
Protected health information
30. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
ethics
(OOPs) Out of Pocket Costs/Expenses
pcp
Protected health information
31. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Privacy officer
(POS) Point-of Service Plan
hmo
32. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
AMA
privacy
electronic media
33. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured
Privileged information
fraud
(AOB) Assignment of Benefits
covered entity
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
Supplementary Medical Insurance
claim
clearinghouse
Allowed Expenses
35. Integrating benefits payable under more than one health insurance.
(UCR) Usual - Customary and Reasonable
Coordinated Coverage
(UCR) Usual - Customary and Reasonable
Preauthorization
36. Is a provider who sends the patients for testing or treatment
HIPAA
(UCR) Usual - Customary and Reasonable
(APC) Ambulatory Patient Classifications
referring physician
37. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(DOS) Date of Service
consent
(PPS) Hospital Impatient Prospective Payment System
abuse
38. A willful act by an employee of taking possession of an employer's money
(UR) Utilization review
Consent form
(PEC) Pre-existing condition
Embezzlement
39. 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.
(DRG's)
clearinghouse
business associate
Supplementary Medical Insurance
40. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
(UR) Utilization review
Covered Expenses
fraud
41. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
hmo
cash flow
security officer
42. A privileged communication that may be disclosed only with the patient's permission.
(DOS) Date of Service
authorization form
Beneficiary
Confidential communication
43. 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
nonprivileged information
(APC) Ambulatory Patient Classifications
closed panel HMO
Open Enrollment
44. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Protected health information
Treating or performing physician
Medigap Insurance
Claim
45. The maximum amount a plan pays for a covered service
state preemption
Allowed Expenses
clearinghouse
Notice of Privacy Practices
46. 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.
Notice of Privacy Practices
Pre-existing Condition Exclusion
IIHI
Out of Network (OON)
47. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
HIPAA
(COBRA)
(ERISA) Employee Retirement Income Security Act of 1974
Treating or performing physician
48. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
attending physician
Resonable Charge
ppo
Specialist
49. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
nonprivileged information
hmo
AMA
(PEC) Pre-existing condition
50. 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
transaction
(ERISA) Employee Retirement Income Security Act of 1974
Security Rule
(PCN) Primary Care Network