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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. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(AOB) Assignment of Benefits
Subscriber
Coordinated Coverage
state preemption
2. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
closed panel HMO
Confidential communication
Network
3. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Supplementary Medical Insurance
epo
Coordinated Coverage
4. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Protected health information
referral
benefit period
5. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
ethics
consent
Amblatory Care
6. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
referring physician
Assignment & Authorization
ordering physician
7. 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
(AOB) Assignment of Benefits
privacy
Covered Expenses
open panel HMO
8. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Privacy officer
(AOB) Assignment of Benefits
ethics
ordering physician
9. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
disclosure
closed panel HMO
(COBRA)
Deductible
10. A monthly fee paid by the insured for specific medical insurance coverage
ppo
premium
deductible
(ERISA) Employee Retirement Income Security Act of 1974
11. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
(PCN) Primary Care Network
(COB) Coordination of Benefits
(UR) Utilization review
12. The condition of being secluded from the presence or view of others.
Allowed Expenses
(POS) Point-of Service Plan
privacy
Resonable Charge
13. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
pcp
etiquette
phantom billing
(OOPs) Out of Pocket Costs/Expenses
14. 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
business associate
Maximum Out Of Pocket
Treating or performing physician
Allowed Expenses
15. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
fraud
(DRG's)
(PCN) Primary Care Network
ee schedule
16. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Pre-existing Condition Exclusion
pcp
Protected health information
business associate
17. 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
business associate
(DCI) Duplicate Coverage Inquiry
phantom billing
18. 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
(UCR) Usual - Customary and Reasonable
etiquette
claim
19. A health insurance enrollee chooses to see an out of network provider without authorization
(TPA) Third Party Administrator
Pre-existing Condition Exclusion
self-referral
Allowed Expenses
20. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
complience plan
Subscriber
transaction
prepaid plan
21. Standards of conduct generally accepted as a moral guide for behavior.
(UCR) Usual - Customary and Reasonable
ordering physician
state preemption
ethics
22. 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
complience
Supplementary Medical Insurance
Resonable Charge
23. Customs - rules of conduct - courtesy - and manners of the medical profession
(UR) Utilization review
etiquette
(PAC) Pre- Admission Certification
ppo
24. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
health care provider
Network
deductible
referral
25. 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
electronic media
(APC) Ambulatory Patient Classifications
Maximum Out Of Pocket
Medigap Insurance
26. 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.
Treating or performing physician
ee schedule
Notice of Privacy Practices
consulting physician
27. 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.
disclosure
claim
attending physician
state preemption
28. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
self-referral
Confidential communication
health care provider
Pre-certification
29. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Assignment & Authorization
Pre-certification
cash flow
econdary Payer
30. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
crossover claim
Covered Expenses
(OOPs) Out of Pocket Costs/Expenses
abuse
31. A structure for classifying outpatient services and procedures for purpose of payment
ids
Protected health information
(APC) Ambulatory Patient Classifications
medical foundation
32. 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
referring physician
preauthorization
confidentiality
33. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
Claim
Protected health information
Supplementary Medical Insurance
confidentiality
34. 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
Pre-certification
pos
(PAC) Pre- Admission Certification
35. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
hmo
Deductible
(OOPs) Out of Pocket Costs/Expenses
36. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
self-referral
(UCR) Usual - Customary and Reasonable
disclosure
Network
37. 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
authorization form
e-health information management
attending physician
(PCN) Primary Care Network
38. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
health care provider
cash flow
(PEC) Pre-existing condition
(PCN) Primary Care Network
39. A nonprofit integrated delivery system
medical foundation
Covered Expenses
phantom billing
(PEC) Pre-existing condition
40. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
claim
Network
Participating Provider
confidentiality
41. 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
Consent form
Open Enrollment
(DME) Durable Medical Equipment
econdary Payer
42. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
Privacy officer
Preauthorization
Standard
Coordinated Coverage
43. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
security officer
(COB) Coordination of Benefits
breach of confidential communication
subscriber
44. 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
(DCI) Duplicate Coverage Inquiry
epo
benefit period
(PCP) Primary Care Physician
45. The condition of being secluded from the presence or view of others.
nonprivileged information
privacy
subscriber
ordering physician
46. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
complience
breach of confidential communication
etiquette
47. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
(COBRA)
Confidential communication
preauthorization
Notice of Privacy Practices
48. 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.
state preemption
Subscriber
ordering physician
(PEC) Pre-existing condition
49. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
attending physician
Pre-existing Condition Exclusion
Notice of Privacy Practices
50. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Embezzlement
Referral
Participating Provider
(PCN) Primary Care Network