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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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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
(COBRA)
deductible
(UR) Utilization review
Resonable Charge
2. 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
health care provider
(ABN) Advance Beneficiary Notice
(POS) Point-of Service Plan
Preauthorization
3. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
health care provider
hmo
(DME) Durable Medical Equipment
(EPO) Exclusive Provider Organization
4. Billing for services not performed
(ERISA) Employee Retirement Income Security Act of 1974
Embezzlement
(PEC) Pre-existing condition
phantom billing
5. 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.
Participating Provider
Supplementary Medical Insurance
attending physician
Notice of Privacy Practices
6. A health insurance enrollee chooses to see an out of network provider without authorization
(DOS) Date of Service
Notice of Privacy Practices
self-referral
Maximum Out Of Pocket
7. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
Out of Network (OON)
ppo
open panel HMO
state preemption
8. Individually identifiable health information
Experimental Procedures
(COBRA)
HIPAA
IIHI
9. The condition of being secluded from the presence or view of others.
privacy
referral
complience plan
nonprivileged information
10. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
breach of confidential communication
attending physician
privacy
11. Is the provider who renders a service to a patient
Treating or performing physician
pcp
Pre-certification
crossover claim
12. Medicare's method of paying acute care hospitals for inpatient care
Experimental Procedures
Beneficiary
(PPS) Hospital Impatient Prospective Payment System
fraud
13. A review of the need for inpatient hospital care - completed before the actual admission
privacy
consulting physician
abuse
(PAC) Pre- Admission Certification
14. 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
electronic media
Supplementary Medical Insurance
Pre-existing Condition Exclusion
15. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(PCP) Primary Care Physician
consulting physician
Assignment & Authorization
(OOPs) Out of Pocket Costs/Expenses
16. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
transaction
(EPO) Exclusive Provider Organization
Preauthorization
Beneficiary
17. Billing for services not performed
phantom billing
health care provider
breach of confidential communication
complience
18. 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
Amblatory Care
Sub-acute Care
medical foundation
Pre-existing Condition Exclusion
19. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
premium
state preemption
referring physician
20. American Medical Association
authorization form
Notice of Privacy Practices
AMA
transaction
21. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Pre-certification
Specialist
Notice of Privacy Practices
e-health information management
22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
cash flow
abuse
(PCN) Primary Care Network
Embezzlement
23. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(COB) Coordination of Benefits
ids
pcp
Medigap Insurance
24. 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
Maximum Out Of Pocket
ppo
(PCP) Primary Care Physician
Security Rule
25. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
(EPO) Exclusive Provider Organization
Pre-certification
Specialist
26. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)
(EPO) Exclusive Provider Organization
Security Rule
subscriber
Consent form
27. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
etiquette
(OOPs) Out of Pocket Costs/Expenses
confidentiality
Out of Network (OON)
28. Standards of conduct generally accepted as a moral guide for behavior.
Consent form
ethics
(PAC) Pre- Admission Certification
(COB) Coordination of Benefits
29. The maximum amount a plan pays for a covered service
ordering physician
(PCN) Primary Care Network
consent
Allowed Expenses
30. 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.
(AOB) Assignment of Benefits
health care provider
confidentiality
ordering physician
31. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Amblatory Care
crossover claim
Privacy officer
32. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Coordinated Coverage
(PEC) Pre-existing condition
Referral
(ABN) Advance Beneficiary Notice
33. 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
(PCP) Primary Care Physician
(POS) Point-of Service Plan
transaction
pos
34. The amount of actual money available to the medical practice
claim
Sub-acute Care
(UR) Utilization review
cash flow
35. 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
(DME) Durable Medical Equipment
(OOPs) Out of Pocket Costs/Expenses
health care provider
e-health information management
36. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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37. A monthly fee paid by the insured for specific medical insurance coverage
e-health information management
(PEC) Pre-existing condition
confidentiality
premium
38. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(TPA) Third Party Administrator
health care provider
(AOB) Assignment of Benefits
39. 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
subscriber
Deductible
deductible
Participating Provider
40. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
closed panel HMO
preauthorization
IIHI
Claim
41. 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
pcp
(DRG's)
(PCP) Primary Care Physician
(AOB) Assignment of Benefits
42. An organization of provider sites with a contracted relationship that offer services
Confidential communication
Privileged information
complience plan
ids
43. Medical staff member who is legally responsible for the care and treatment given to a patient.
Protected health information
pcp
attending physician
Preauthorization
44. The period of time that payment for Medicare inpatient hospital benefits are available
self-referral
(ABN) Advance Beneficiary Notice
benefit period
(ERISA) Employee Retirement Income Security Act of 1974
45. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
security officer
Deductible
hmo
Coordinated Coverage
46. An intentional misrepresentation of the facts to deceive or mislead another.
etiquette
Coordinated Coverage
Subscriber
fraud
47. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
Pre-certification
(OOPs) Out of Pocket Costs/Expenses
(UR) Utilization review
48. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Treating or performing physician
pcp
(OOPs) Out of Pocket Costs/Expenses
benefit period
49. 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.
Subscriber
(APC) Ambulatory Patient Classifications
(PAC) Pre- Admission Certification
Privileged information
50. 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
attending physician
complience
Supplementary Medical Insurance
fraud