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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. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
business associate
Consent form
self-referral
Pre-certification
2. Individually identifiable health information
hmo
IIHI
Out of Network (OON)
Individually identifiable health information
3. A willful act by an employee of taking possession of an employer's money
breach of confidential communication
business associate
Embezzlement
Out of Network (OON)
4. 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 Rule
(DRG's)
(POS) Point-of Service Plan
abuse
5. 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
Individually identifiable health information
ee schedule
(POS) Point-of Service Plan
6. 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
prepaid plan
Privileged information
Participating Provider
(Non-par) Non-Participating Provider
7. Medical services provided on an outpatient basis
claim
Privacy officer
Amblatory Care
hmo
8. 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
consulting physician
(ABN) Advance Beneficiary Notice
Out of Network (OON)
deductible
9. What the insurance company will consider paying for as defined in the contract.
subscriber
Covered Expenses
privacy
abuse
10. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Protected health information
abuse
pcp
attending physician
11. 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
breach of confidential communication
Open Enrollment
Allowed Expenses
Experimental Procedures
12. The condition of being secluded from the presence or view of others.
Specialist
privacy
(ABN) Advance Beneficiary Notice
IIHI
13. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Beneficiary
transaction
(DME) Durable Medical Equipment
referring physician
14. 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
Medigap Insurance
Coordinated Coverage
business associate
15. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
Consent form
consulting physician
Protected health information
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
Specialist
(POS) Point-of Service Plan
ee schedule
covered entity
17. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
transaction
e-health information management
IIHI
Treating or performing physician
18. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
Experimental Procedures
subscriber
Beneficiary
19. An intentional misrepresentation of the facts to deceive or mislead another.
Assignment & Authorization
Subscriber
fraud
Claim
20. A rule - condition - or requirement
(DOS) Date of Service
Allowed Expenses
Standard
authorization form
21. 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
(PCN) Primary Care Network
prepaid plan
Network
ordering physician
22. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
deductible
complience
referral
(PPS) Hospital Impatient Prospective Payment System
23. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
ee schedule
(OOPs) Out of Pocket Costs/Expenses
(ERISA) Employee Retirement Income Security Act of 1974
Specialist
24. 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
(UR) Utilization review
referral
pos
Amblatory Care
25. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Pre-existing Condition Exclusion
cash flow
(POS) Point-of Service Plan
(UCR) Usual - Customary and Reasonable
26. 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
Amblatory Care
disclosure
claim
27. A monthly fee paid by the insured for specific medical insurance coverage
consent
benefit period
security officer
premium
28. 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
(PAC) Pre- Admission Certification
AMA
Supplementary Medical Insurance
Referral
29. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
hmo
(OOPs) Out of Pocket Costs/Expenses
(AOB) Assignment of Benefits
pcp
30. 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
ee schedule
Standard
Notice of Privacy Practices
(ERISA) Employee Retirement Income Security Act of 1974
31. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Confidential communication
hmo
subscriber
(OOPs) Out of Pocket Costs/Expenses
32. Is the provider who renders a service to a patient
security officer
Treating or performing physician
Confidential communication
econdary Payer
33. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Beneficiary
ee schedule
attending physician
34. 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
state preemption
claim
Security Rule
preauthorization
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.
Amblatory Care
Privacy officer
(PEC) Pre-existing condition
etiquette
36. The period of time that payment for Medicare inpatient hospital benefits are available
Allowed Expenses
subscriber
benefit period
Supplementary Medical Insurance
37. 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
Supplementary Medical Insurance
ordering physician
abuse
epo
38. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
etiquette
(TPA) Third Party Administrator
Allowed Expenses
benefit period
39. Medical staff member who is legally responsible for the care and treatment given to a patient.
transaction
Resonable Charge
claim
attending physician
40. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou
Sub-acute Care
business associate
privacy
breach of confidential communication
41. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
electronic media
Referral
claim
42. Health Information Portability and Accountability Act
HIPAA
Confidential communication
Resonable Charge
(APC) Ambulatory Patient Classifications
43. 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
Privileged information
(POS) Point-of Service Plan
transaction
epo
44. 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
Standard
(DME) Durable Medical Equipment
Claim
nonprivileged information
45. Someone who is eligible for or receiving benefits under an insurance policy or plan
Amblatory Care
consent
Beneficiary
Participating Provider
46. The period of time that payment for Medicare inpatient hospital benefits are available
ids
Protected health information
benefit period
Notice of Privacy Practices
47. 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
electronic media
ee schedule
Medigap Insurance
48. Billing for services not performed
crossover claim
Subscriber
Open Enrollment
phantom billing
49. A structure for classifying outpatient services and procedures for purpose of payment
(PAC) Pre- Admission Certification
Consent form
Pre-existing Condition Exclusion
(APC) Ambulatory Patient Classifications
50. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Referral
Assignment & Authorization
subscriber
(DME) Durable Medical Equipment