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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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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 staff member who is legally responsible for the care and treatment given to a patient.
Experimental Procedures
IIHI
pos
attending physician
2. A nonprofit integrated delivery system
Referral
medical foundation
benefit period
pos
3. 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
attending physician
phantom billing
nonprivileged information
Protected health information
4. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
open panel HMO
IIHI
AMA
Medigap Insurance
5. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
privacy
(AOB) Assignment of Benefits
AMA
(UR) Utilization review
6. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Notice of Privacy Practices
Beneficiary
(OOPs) Out of Pocket Costs/Expenses
breach of confidential communication
7. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Supplementary Medical Insurance
electronic media
Treating or performing physician
8. 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
health care provider
Supplementary Medical Insurance
deductible
9. 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
breach of confidential communication
state preemption
AMA
Open Enrollment
10. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
crossover claim
e-health information management
(TPA) Third Party Administrator
confidentiality
11. 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.
state preemption
security officer
Supplementary Medical Insurance
Consent form
12. Customs - rules of conduct - courtesy - and manners of the medical profession
fraud
complience
Assignment & Authorization
etiquette
13. Verbal or written agreement that gives approval to some action - situation - or statement.
Individually identifiable health information
consent
IIHI
Subscriber
14. An organization of provider sites with a contracted relationship that offer services
Maximum Out Of Pocket
ids
(DME) Durable Medical Equipment
consent
15. An organization of provider sites with a contracted relationship that offer services
ids
Embezzlement
ppo
ee schedule
16. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
security officer
Pre-existing Condition Exclusion
IIHI
(EPO) Exclusive Provider Organization
17. The condition of being secluded from the presence or view of others.
ppo
privacy
Security Rule
disclosure
18. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Notice of Privacy Practices
(DRG's)
Privileged information
19. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
hmo
Deductible
consulting physician
Subscriber
20. American Medical Association
Experimental Procedures
(OOPs) Out of Pocket Costs/Expenses
AMA
(DME) Durable Medical Equipment
21. 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
Participating Provider
Medigap Insurance
(AOB) Assignment of Benefits
Preauthorization
22. Medicare's method of paying acute care hospitals for inpatient care
(TPA) Third Party Administrator
(PPS) Hospital Impatient Prospective Payment System
nonprivileged information
(PEC) Pre-existing condition
23. The amount of actual money available to the medical practice
cash flow
(PEC) Pre-existing condition
(COB) Coordination of Benefits
clearinghouse
24. 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
business associate
abuse
(PCN) Primary Care Network
Pre-existing Condition Exclusion
25. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
transaction
benefit period
(UCR) Usual - Customary and Reasonable
Specialist
26. Is the provider who renders a service to a patient
Treating or performing physician
ids
Notice of Privacy Practices
covered entity
27. 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
privacy
ordering physician
authorization form
claim
28. 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.
business associate
ethics
referring physician
(PPS) Hospital Impatient Prospective Payment System
29. 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
Allowed Expenses
(EPO) Exclusive Provider Organization
(OOPs) Out of Pocket Costs/Expenses
(DME) Durable Medical Equipment
30. 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
hmo
Pre-existing Condition Exclusion
Maximum Out Of Pocket
Medigap Insurance
31. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
premium
Amblatory Care
(OOPs) Out of Pocket Costs/Expenses
prepaid plan
32. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(COB) Coordination of Benefits
fraud
HIPAA
clearinghouse
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
(DCI) Duplicate Coverage Inquiry
pos
claim
(PPS) Hospital Impatient Prospective Payment System
34. 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
(ABN) Advance Beneficiary Notice
Beneficiary
open panel HMO
crossover claim
35. 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.
disclosure
Privacy officer
Experimental Procedures
transaction
36. A list of the amount to be paid by an insurance company for each procedure service
Maximum Out Of Pocket
ee schedule
(TPA) Third Party Administrator
Experimental Procedures
37. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
pcp
prepaid plan
epo
Preauthorization
38. 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
nonprivileged information
(DOS) Date of Service
Assignment & Authorization
etiquette
39. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(PPS) Hospital Impatient Prospective Payment System
Network
Preauthorization
Referral
40. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
authorization form
Notice of Privacy Practices
pos
41. 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
deductible
consulting physician
crossover claim
Supplementary Medical Insurance
42. 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)
Consent form
consent
crossover claim
ee schedule
43. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
phantom billing
Maximum Out Of Pocket
(PPS) Hospital Impatient Prospective Payment System
44. A nonprofit integrated delivery system
medical foundation
Assignment & Authorization
Referral
electronic media
45. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(DRG's)
abuse
(DRG's)
Referral
46. Standards of conduct generally accepted as a moral guide for behavior.
(Non-par) Non-Participating Provider
ethics
Pre-existing Condition Exclusion
(Non-par) Non-Participating Provider
47. 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
(TPA) Third Party Administrator
Security Rule
Amblatory Care
(DCI) Duplicate Coverage Inquiry
48. 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.
(DRG's)
Maximum Out Of Pocket
Notice of Privacy Practices
(ERISA) Employee Retirement Income Security Act of 1974
49. 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
(DOS) Date of Service
Consent form
(PCP) Primary Care Physician
(DRG's)
50. 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.
Consent form
ids
Privileged information
Deductible