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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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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. 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
(OOPs) Out of Pocket Costs/Expenses
Beneficiary
health care provider
(Non-par) Non-Participating Provider
2. The maximum amount a plan pays for a covered service
IIHI
self-referral
Allowed Expenses
(OOPs) Out of Pocket Costs/Expenses
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
Privacy officer
nonprivileged information
phantom billing
covered entity
4. 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.
complience plan
Privileged information
(DRG's)
attending physician
5. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Specialist
(ERISA) Employee Retirement Income Security Act of 1974
disclosure
breach of confidential communication
6. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
abuse
Medigap Insurance
complience plan
phantom billing
7. Is a provider who sends the patients for testing or treatment
referring physician
Beneficiary
Protected health information
Coordinated Coverage
8. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
state preemption
Claim
Confidential communication
Pre-certification
9. The period of time that payment for Medicare inpatient hospital benefits are available
(ERISA) Employee Retirement Income Security Act of 1974
self-referral
(TPA) Third Party Administrator
benefit period
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
prepaid plan
(COB) Coordination of Benefits
covered entity
epo
11. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
closed panel HMO
(PPS) Hospital Impatient Prospective Payment System
complience plan
12. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Embezzlement
Embezzlement
Claim
13. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(COB) Coordination of Benefits
confidentiality
covered entity
hmo
14. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
fraud
business associate
confidentiality
15. 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
(DCI) Duplicate Coverage Inquiry
Allowed Expenses
(DME) Durable Medical Equipment
authorization form
16. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
consent
Referral
self-referral
17. 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
cash flow
(ERISA) Employee Retirement Income Security Act of 1974
pcp
ppo
18. Billing for services not performed
abuse
(COBRA)
phantom billing
(PAC) Pre- Admission Certification
19. 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
claim
authorization form
(PCP) Primary Care Physician
Maximum Out Of Pocket
20. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Out of Network (OON)
transaction
pcp
(PCN) Primary Care Network
21. The maximum amount a plan pays for a covered service
Allowed Expenses
covered entity
Treating or performing physician
Sub-acute Care
22. 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)
hmo
nonprivileged information
Consent form
referring physician
23. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
econdary Payer
(PEC) Pre-existing condition
(POS) Point-of Service Plan
IIHI
24. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
self-referral
Subscriber
abuse
econdary Payer
25. A list of the amount to be paid by an insurance company for each procedure service
Referral
(EPO) Exclusive Provider Organization
ee schedule
subscriber
26. Health Information Portability and Accountability Act
Out of Network (OON)
HIPAA
(DOS) Date of Service
Protected health information
27. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
(PAC) Pre- Admission Certification
covered entity
Resonable Charge
28. 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
(PEC) Pre-existing condition
referring physician
deductible
29. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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30. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
breach of confidential communication
Supplementary Medical Insurance
(EPO) Exclusive Provider Organization
ordering physician
31. 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
e-health information management
Subscriber
(POS) Point-of Service Plan
Experimental Procedures
32. 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
(TPA) Third Party Administrator
referral
Consent form
33. Approval or consent by a primary physician for patient referral to ancillary services and specialists
nonprivileged information
Referral
Pre-certification
Treating or performing physician
34. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(EPO) Exclusive Provider Organization
deductible
(PAC) Pre- Admission Certification
consent
35. 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.
(UCR) Usual - Customary and Reasonable
business associate
Deductible
(ABN) Advance Beneficiary Notice
36. A structure for classifying outpatient services and procedures for purpose of payment
cash flow
Notice of Privacy Practices
authorization form
(APC) Ambulatory Patient Classifications
37. 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.
Privileged information
prepaid plan
(PEC) Pre-existing condition
(DME) Durable Medical Equipment
38. 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
prepaid plan
Experimental Procedures
Privacy officer
e-health information management
39. Medical staff member who is legally responsible for the care and treatment given to a patient.
closed panel HMO
pcp
crossover claim
attending physician
40. Individually identifiable health information
closed panel HMO
IIHI
(UR) Utilization review
covered entity
41. A rule - condition - or requirement
prepaid plan
Standard
(EPO) Exclusive Provider Organization
(COBRA)
42. 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
consulting physician
prepaid plan
benefit period
Embezzlement
43. Medical services provided on an outpatient basis
Allowed Expenses
Security Rule
Maximum Out Of Pocket
Amblatory Care
44. 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
Beneficiary
confidentiality
(ABN) Advance Beneficiary Notice
open panel HMO
45. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
security officer
medical foundation
Open Enrollment
econdary Payer
46. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(AOB) Assignment of Benefits
health care provider
complience
pcp
47. Integrating benefits payable under more than one health insurance.
deductible
Coordinated Coverage
clearinghouse
(Non-par) Non-Participating Provider
48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
disclosure
AMA
Privileged information
abuse
49. 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
open panel HMO
Specialist
Assignment & Authorization
(DRG's)
50. 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
(POS) Point-of Service Plan
ppo
Supplementary Medical Insurance