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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. Medical services provided on an outpatient basis
Sub-acute Care
(ABN) Advance Beneficiary Notice
(UCR) Usual - Customary and Reasonable
Amblatory Care
2. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Beneficiary
Assignment & Authorization
claim
state preemption
3. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
(COB) Coordination of Benefits
Confidential communication
Supplementary Medical Insurance
4. A provision that apples when a person is covered under more than one group medical program
pcp
(COB) Coordination of Benefits
authorization form
state preemption
5. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
crossover claim
(EPO) Exclusive Provider Organization
fraud
Network
6. Is the provider who renders a service to a patient
(PPS) Hospital Impatient Prospective Payment System
Treating or performing physician
attending physician
ee schedule
7. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(DCI) Duplicate Coverage Inquiry
claim
(DME) Durable Medical Equipment
e-health information management
8. Individually identifiable health information
Open Enrollment
(ABN) Advance Beneficiary Notice
consent
IIHI
9. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
ids
prepaid plan
subscriber
Pre-certification
10. 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
covered entity
Protected health information
attending physician
Consent form
11. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(DME) Durable Medical Equipment
Security Rule
electronic media
(DRG's)
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
(PAC) Pre- Admission Certification
Subscriber
attending physician
Sub-acute Care
13. 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
Beneficiary
IIHI
(POS) Point-of Service Plan
fraud
14. An intentional misrepresentation of the facts to deceive or mislead another.
confidentiality
fraud
Privileged information
open panel HMO
15. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
(UR) Utilization review
abuse
(PAC) Pre- Admission Certification
16. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.
consulting physician
security officer
ppo
crossover claim
17. 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
pos
(UR) Utilization review
Open Enrollment
Amblatory Care
18. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Out of Network (OON)
Supplementary Medical Insurance
disclosure
consulting physician
19. American Medical Association
ppo
AMA
Beneficiary
Consent form
20. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Security Rule
Specialist
premium
covered entity
21. The condition of being secluded from the presence or view of others.
Covered Expenses
cash flow
electronic media
privacy
22. A rule - condition - or requirement
Standard
claim
security officer
ordering physician
23. 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
(COBRA)
preauthorization
state preemption
Maximum Out Of Pocket
24. A nonprofit integrated delivery system
(OOPs) Out of Pocket Costs/Expenses
medical foundation
(AOB) Assignment of Benefits
Resonable Charge
25. 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.
state preemption
Amblatory Care
Maximum Out Of Pocket
(UR) Utilization review
26. 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
medical foundation
(ERISA) Employee Retirement Income Security Act of 1974
consulting physician
closed panel HMO
27. 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.
attending physician
Assignment & Authorization
IIHI
Protected health information
28. 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
(DRG's)
ids
crossover claim
(ABN) Advance Beneficiary Notice
29. 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.
Protected health information
ee schedule
breach of confidential communication
business associate
30. A monthly fee paid by the insured for specific medical insurance coverage
nonprivileged information
(DCI) Duplicate Coverage Inquiry
deductible
premium
31. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
IIHI
(UR) Utilization review
Assignment & Authorization
complience
32. 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.
ee schedule
Protected health information
Covered Expenses
Privacy officer
33. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
phantom billing
Individually identifiable health information
Experimental Procedures
34. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
closed panel HMO
consulting physician
(POS) Point-of Service Plan
35. 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
(EPO) Exclusive Provider Organization
IIHI
referring physician
36. Billing for services not performed
privacy
Specialist
phantom billing
(UCR) Usual - Customary and Reasonable
37. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
(PPS) Hospital Impatient Prospective Payment System
(ERISA) Employee Retirement Income Security Act of 1974
privacy
38. Unauthorized release of information
(PCP) Primary Care Physician
pcp
breach of confidential communication
preauthorization
39. 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
(DCI) Duplicate Coverage Inquiry
state preemption
Open Enrollment
authorization form
40. 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
Supplementary Medical Insurance
(APC) Ambulatory Patient Classifications
Deductible
electronic media
41. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(OOPs) Out of Pocket Costs/Expenses
Specialist
(DME) Durable Medical Equipment
Participating Provider
42. 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
Referral
crossover claim
Sub-acute Care
Supplementary Medical Insurance
43. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
ids
(OOPs) Out of Pocket Costs/Expenses
Specialist
Embezzlement
44. The period of time that payment for Medicare inpatient hospital benefits are available
fraud
benefit period
(PAC) Pre- Admission Certification
Specialist
45. 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.
econdary Payer
Privileged information
Pre-certification
transaction
46. 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
(ERISA) Employee Retirement Income Security Act of 1974
Assignment & Authorization
Consent form
business associate
47. 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
epo
attending physician
Out of Network (OON)
Participating Provider
48. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
nonprivileged information
phantom billing
pcp
hmo
49. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
AMA
attending physician
Beneficiary
50. 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
abuse
Open Enrollment
nonprivileged information
ethics