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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 structure for classifying outpatient services and procedures for purpose of payment
(EPO) Exclusive Provider Organization
(COB) Coordination of Benefits
(PPS) Hospital Impatient Prospective Payment System
(APC) Ambulatory Patient Classifications
2. 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
premium
confidentiality
(EPO) Exclusive Provider Organization
3. 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
ppo
(AOB) Assignment of Benefits
crossover claim
(DOS) Date of Service
4. Unauthorized release of information
(AOB) Assignment of Benefits
benefit period
breach of confidential communication
consulting physician
5. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
ordering physician
pcp
Experimental Procedures
pos
6. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(DCI) Duplicate Coverage Inquiry
Covered Expenses
(OOPs) Out of Pocket Costs/Expenses
epo
7. A privileged communication that may be disclosed only with the patient's permission.
pos
Security Rule
Confidential communication
ee schedule
8. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Covered Expenses
subscriber
pos
9. Unauthorized release of information
(COBRA)
breach of confidential communication
(EPO) Exclusive Provider Organization
covered entity
10. 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.
nonprivileged information
(EPO) Exclusive Provider Organization
transaction
state preemption
11. 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
ethics
(DME) Durable Medical Equipment
(DRG's)
Pre-existing Condition Exclusion
12. An organization of provider sites with a contracted relationship that offer services
disclosure
referral
Allowed Expenses
ids
13. A patient claim is eligible for medicare and medicaid
cash flow
Notice of Privacy Practices
crossover claim
Participating Provider
14. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Individually identifiable health information
transaction
clearinghouse
self-referral
15. 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
transaction
clearinghouse
pcp
ppo
16. 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
security officer
(Non-par) Non-Participating Provider
(POS) Point-of Service Plan
abuse
17. 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
epo
attending physician
Security Rule
authorization form
18. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(EPO) Exclusive Provider Organization
(UR) Utilization review
transaction
consent
19. 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
privacy
subscriber
Claim
20. 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
Assignment & Authorization
Pre-existing Condition Exclusion
Amblatory Care
21. What the insurance company will consider paying for as defined in the contract.
transaction
Covered Expenses
e-health information management
(PCN) Primary Care Network
22. 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
Out of Network (OON)
(PAC) Pre- Admission Certification
Medigap Insurance
(PCP) Primary Care Physician
23. A clinic that is owned by the HMO and the physicians are employees of the HMO
Privileged information
closed panel HMO
Participating Provider
crossover claim
24. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(PCP) Primary Care Physician
electronic media
confidentiality
transaction
25. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
state preemption
Consent form
deductible
Medigap Insurance
26. 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.
(PAC) Pre- Admission Certification
health care provider
Notice of Privacy Practices
(EPO) Exclusive Provider Organization
27. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
business associate
Participating Provider
Maximum Out Of Pocket
28. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
IIHI
(PCN) Primary Care Network
subscriber
AMA
29. The maximum amount a plan pays for a covered service
ids
Allowed Expenses
Network
breach of confidential communication
30. Approval or consent by a primary physician for patient referral to ancillary services and specialists
epo
(Non-par) Non-Participating Provider
Referral
ordering physician
31. 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
(EPO) Exclusive Provider Organization
Open Enrollment
Supplementary Medical Insurance
Notice of Privacy Practices
32. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
deductible
(PEC) Pre-existing condition
ee schedule
33. Billing for services not performed
security officer
phantom billing
cash flow
Pre-certification
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
(ABN) Advance Beneficiary Notice
(DCI) Duplicate Coverage Inquiry
(PPS) Hospital Impatient Prospective Payment System
35. 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.
Maximum Out Of Pocket
etiquette
Participating Provider
Privileged information
36. A monthly fee paid by the insured for specific medical insurance coverage
Pre-certification
premium
claim
Open Enrollment
37. 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.
ppo
business associate
crossover claim
Security Rule
38. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
Subscriber
nonprivileged information
Notice of Privacy Practices
Protected health information
39. Is a provider who sends the patients for testing or treatment
claim
referring physician
Embezzlement
Maximum Out Of Pocket
40. Approval or consent by a primary physician for patient referral to ancillary services and specialists
business associate
Participating Provider
Referral
Specialist
41. A patient claim is eligible for medicare and medicaid
Subscriber
(PCP) Primary Care Physician
medical foundation
crossover claim
42. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
consulting physician
Privacy officer
subscriber
(POS) Point-of Service Plan
43. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated
Pre-existing Condition Exclusion
crossover claim
Experimental Procedures
hmo
44. A monthly fee paid by the insured for specific medical insurance coverage
(COB) Coordination of Benefits
epo
premium
(PEC) Pre-existing condition
45. 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
fraud
claim
authorization form
(AOB) Assignment of Benefits
46. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
benefit period
disclosure
Specialist
authorization form
47. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
ids
Network
Allowed Expenses
48. 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
confidentiality
subscriber
(ERISA) Employee Retirement Income Security Act of 1974
(PCP) Primary Care Physician
49. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(OOPs) Out of Pocket Costs/Expenses
privacy
consulting physician
subscriber
50. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(POS) Point-of Service Plan
confidentiality
claim
(COBRA)