SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(COB) Coordination of Benefits
(PPS) Hospital Impatient Prospective Payment System
e-health information management
Protected health information
2. 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
(PAC) Pre- Admission Certification
Experimental Procedures
Open Enrollment
Allowed Expenses
3. 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
authorization form
Maximum Out Of Pocket
Assignment & Authorization
Deductible
4. 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
Network
referring physician
Supplementary Medical Insurance
(POS) Point-of Service Plan
5. 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
attending physician
prepaid plan
subscriber
6. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
crossover claim
Subscriber
(OOPs) Out of Pocket Costs/Expenses
7. 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
Resonable Charge
ppo
Consent form
Coordinated Coverage
8. Integrating benefits payable under more than one health insurance.
e-health information management
Coordinated Coverage
consulting physician
Maximum Out Of Pocket
9. A privileged communication that may be disclosed only with the patient's permission.
(DME) Durable Medical Equipment
referring physician
Confidential communication
deductible
10. A willful act by an employee of taking possession of an employer's money
business associate
Embezzlement
hmo
benefit period
11. A willful act by an employee of taking possession of an employer's money
electronic media
(ABN) Advance Beneficiary Notice
Coordinated Coverage
Embezzlement
12. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Confidential communication
Treating or performing physician
Supplementary Medical Insurance
13. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
(PCP) Primary Care Physician
Confidential communication
Pre-certification
14. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Network
Medigap Insurance
Resonable Charge
Referral
15. Medical staff member who is legally responsible for the care and treatment given to a patient.
nonprivileged information
(ABN) Advance Beneficiary Notice
attending physician
crossover claim
16. The maximum amount a plan pays for a covered service
Allowed Expenses
open panel HMO
Experimental Procedures
Consent form
17. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
privacy
confidentiality
(POS) Point-of Service Plan
Maximum Out Of Pocket
18. Medical staff member who is legally responsible for the care and treatment given to a patient.
health care provider
(COB) Coordination of Benefits
attending physician
HIPAA
19. 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
(ERISA) Employee Retirement Income Security Act of 1974
Notice of Privacy Practices
(DME) Durable Medical Equipment
Allowed Expenses
20. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Privileged information
disclosure
pcp
(DME) Durable Medical Equipment
21. An organization of provider sites with a contracted relationship that offer services
ids
nonprivileged information
closed panel HMO
AMA
22. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
authorization form
referral
attending physician
(DRG's)
23. 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
crossover claim
medical foundation
(Non-par) Non-Participating Provider
preauthorization
24. 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
(AOB) Assignment of Benefits
deductible
Consent form
Beneficiary
25. 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
Beneficiary
Sub-acute Care
Experimental Procedures
Medigap Insurance
26. Billing for services not performed
self-referral
phantom billing
Assignment & Authorization
attending physician
27. What the insurance company will consider paying for as defined in the contract.
pos
(PAC) Pre- Admission Certification
Covered Expenses
(COBRA)
28. 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.
hmo
Pre-certification
ppo
Notice of Privacy Practices
29. Is a provider who sends the patients for testing or treatment
Embezzlement
econdary Payer
referring physician
Consent form
30. An intentional misrepresentation of the facts to deceive or mislead another.
(PPS) Hospital Impatient Prospective Payment System
econdary Payer
fraud
ee schedule
31. 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
(DOS) Date of Service
(Non-par) Non-Participating Provider
(UR) Utilization review
Resonable Charge
32. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PAC) Pre- Admission Certification
(ABN) Advance Beneficiary Notice
transaction
subscriber
33. Medicare's method of paying acute care hospitals for inpatient care
(POS) Point-of Service Plan
(PPS) Hospital Impatient Prospective Payment System
ids
covered entity
34. Is the provider who renders a service to a patient
(DCI) Duplicate Coverage Inquiry
Treating or performing physician
Allowed Expenses
referral
35. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PPS) Hospital Impatient Prospective Payment System
preauthorization
complience
prepaid plan
36. A clinic that is owned by the HMO and the physicians are employees of the HMO
Open Enrollment
complience
attending physician
closed panel HMO
37. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method
epo
referral
Confidential communication
(AOB) Assignment of Benefits
38. 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
Subscriber
complience
(DCI) Duplicate Coverage Inquiry
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.
electronic media
Consent form
business associate
Pre-existing Condition Exclusion
40. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
state preemption
Privileged information
abuse
ethics
41. A health insurance enrollee chooses to see an out of network provider without authorization
Subscriber
self-referral
(DME) Durable Medical Equipment
Amblatory Care
42. 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.
security officer
Preauthorization
Privacy officer
hmo
43. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Embezzlement
IIHI
Pre-existing Condition Exclusion
44. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
AMA
(UCR) Usual - Customary and Reasonable
(COBRA)
preauthorization
45. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(PPS) Hospital Impatient Prospective Payment System
(PCP) Primary Care Physician
(UR) Utilization review
fraud
46. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
(ABN) Advance Beneficiary Notice
(COB) Coordination of Benefits
health care provider
47. 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
disclosure
etiquette
Experimental Procedures
nonprivileged information
48. 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
Individually identifiable health information
(APC) Ambulatory Patient Classifications
covered entity
open panel HMO
49. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(AOB) Assignment of Benefits
open panel HMO
referring physician
50. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
closed panel HMO
prepaid plan
pcp