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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
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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. 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
(TPA) Third Party Administrator
(COBRA)
(POS) Point-of Service Plan
2. Approval or consent by a primary physician for patient referral to ancillary services and specialists
ethics
Standard
Referral
consulting physician
3. Someone who is eligible for or receiving benefits under an insurance policy or plan
(OOPs) Out of Pocket Costs/Expenses
nonprivileged information
Beneficiary
(DCI) Duplicate Coverage Inquiry
4. Is the provider who renders a service to a patient
transaction
Treating or performing physician
Supplementary Medical Insurance
e-health information management
5. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
benefit period
abuse
(DRG's)
HIPAA
6. The dates of healthcare services were provided to the beneficiary
preauthorization
(DOS) Date of Service
consent
Participating Provider
7. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Preauthorization
health care provider
(OOPs) Out of Pocket Costs/Expenses
phantom billing
8. The period of time that payment for Medicare inpatient hospital benefits are available
Embezzlement
Experimental Procedures
benefit period
Coordinated Coverage
9. 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.
Subscriber
authorization form
security officer
(DRG's)
10. 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
Confidential communication
Deductible
(APC) Ambulatory Patient Classifications
(PPS) Hospital Impatient Prospective Payment System
11. Standards of conduct generally accepted as a moral guide for behavior.
fraud
ethics
ppo
abuse
12. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Referral
Experimental Procedures
subscriber
confidentiality
13. Verbal or written agreement that gives approval to some action - situation - or statement.
business associate
consent
(ABN) Advance Beneficiary Notice
HIPAA
14. 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
breach of confidential communication
(EPO) Exclusive Provider Organization
complience plan
15. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
(Non-par) Non-Participating Provider
breach of confidential communication
(UR) Utilization review
16. 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
Maximum Out Of Pocket
consent
consent
17. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
nonprivileged information
AMA
econdary Payer
18. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Consent form
(UCR) Usual - Customary and Reasonable
(ABN) Advance Beneficiary Notice
Pre-existing Condition Exclusion
19. Health Information Portability and Accountability Act
HIPAA
IIHI
Coordinated Coverage
(UR) Utilization review
20. A provision that apples when a person is covered under more than one group medical program
(APC) Ambulatory Patient Classifications
IIHI
(COB) Coordination of Benefits
authorization form
21. 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
ordering physician
(POS) Point-of Service Plan
fraud
electronic media
22. Integrating benefits payable under more than one health insurance.
claim
Resonable Charge
Coordinated Coverage
(PEC) Pre-existing condition
23. 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
Sub-acute Care
open panel HMO
Privacy officer
Referral
24. A monthly fee paid by the insured for specific medical insurance coverage
premium
(PCP) Primary Care Physician
(PEC) Pre-existing condition
HIPAA
25. 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
(DOS) Date of Service
Open Enrollment
(EPO) Exclusive Provider Organization
subscriber
26. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
cash flow
clearinghouse
prepaid plan
nonprivileged information
27. 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
fraud
(OOPs) Out of Pocket Costs/Expenses
Referral
28. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
deductible
(OOPs) Out of Pocket Costs/Expenses
Security Rule
confidentiality
29. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
clearinghouse
etiquette
Claim
30. A monthly fee paid by the insured for specific medical insurance coverage
(PAC) Pre- Admission Certification
premium
(COBRA)
health care provider
31. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
pos
hmo
(DME) Durable Medical Equipment
(TPA) Third Party Administrator
32. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
medical foundation
claim
Specialist
(EPO) Exclusive Provider Organization
33. A list of the amount to be paid by an insurance company for each procedure service
Supplementary Medical Insurance
state preemption
ee schedule
claim
34. 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
Deductible
(DOS) Date of Service
Assignment & Authorization
Participating Provider
35. 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.
etiquette
(COBRA)
Notice of Privacy Practices
Standard
36. 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
(PPS) Hospital Impatient Prospective Payment System
Sub-acute Care
Privacy officer
37. Individually identifiable health information
self-referral
IIHI
prepaid plan
Individually identifiable health information
38. 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
Treating or performing physician
Supplementary Medical Insurance
(PCP) Primary Care Physician
ordering physician
39. 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
Participating Provider
Treating or performing physician
nonprivileged information
(UCR) Usual - Customary and Reasonable
40. 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
crossover claim
(COB) Coordination of Benefits
Experimental Procedures
(ABN) Advance Beneficiary Notice
41. The dates of healthcare services were provided to the beneficiary
(PCP) Primary Care Physician
(UCR) Usual - Customary and Reasonable
(DOS) Date of Service
etiquette
42. A health insurance enrollee chooses to see an out of network provider without authorization
econdary Payer
self-referral
(PAC) Pre- Admission Certification
Experimental Procedures
43. Unauthorized release of information
Network
breach of confidential communication
Open Enrollment
premium
44. The maximum amount a plan pays for a covered service
fraud
(PAC) Pre- Admission Certification
Allowed Expenses
ethics
45. 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.
epo
Allowed Expenses
(TPA) Third Party Administrator
business associate
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
electronic media
complience plan
Assignment & Authorization
state preemption
47. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
(DCI) Duplicate Coverage Inquiry
covered entity
(UR) Utilization review
48. The condition of being secluded from the presence or view of others.
(PCN) Primary Care Network
claim
privacy
Maximum Out Of Pocket
49. The maximum amount a plan pays for a covered service
Allowed Expenses
ethics
fraud
covered entity
50. 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
(PCN) Primary Care Network
(Non-par) Non-Participating Provider
Pre-certification
(DRG's)