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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. 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
Maximum Out Of Pocket
Participating Provider
Deductible
business associate
2. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Embezzlement
ordering physician
(EPO) Exclusive Provider Organization
(AOB) Assignment of Benefits
3. 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
security officer
Preauthorization
Claim
4. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Preauthorization
e-health information management
(DOS) Date of Service
(TPA) Third Party Administrator
5. 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
clearinghouse
e-health information management
nonprivileged information
pos
6. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(DME) Durable Medical Equipment
abuse
IIHI
Security Rule
7. 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.
epo
Supplementary Medical Insurance
ordering physician
Privileged information
8. 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
Consent form
Standard
Deductible
covered entity
9. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
closed panel HMO
(DME) Durable Medical Equipment
(PAC) Pre- Admission Certification
10. A structure for classifying outpatient services and procedures for purpose of payment
ordering physician
(APC) Ambulatory Patient Classifications
Deductible
Beneficiary
11. Standards of conduct generally accepted as a moral guide for behavior.
breach of confidential communication
epo
closed panel HMO
ethics
12. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
clearinghouse
Protected health information
Specialist
Resonable Charge
13. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
medical foundation
(DRG's)
breach of confidential communication
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
self-referral
(PEC) Pre-existing condition
Pre-existing Condition Exclusion
(EPO) Exclusive Provider Organization
15. 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
AMA
Beneficiary
fraud
16. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(DCI) Duplicate Coverage Inquiry
complience
(UCR) Usual - Customary and Reasonable
crossover claim
17. 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.
closed panel HMO
business associate
ppo
etiquette
18. A nonprofit integrated delivery system
medical foundation
etiquette
deductible
prepaid plan
19. 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
self-referral
open panel HMO
Embezzlement
complience plan
20. 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
benefit period
medical foundation
prepaid plan
HIPAA
21. 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
clearinghouse
HIPAA
cash flow
Sub-acute Care
22. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Subscriber
Covered Expenses
premium
ordering physician
23. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
preauthorization
Protected health information
Resonable Charge
closed panel HMO
24. 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
Consent form
business associate
(AOB) Assignment of Benefits
25. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(APC) Ambulatory Patient Classifications
Individually identifiable health information
Embezzlement
security officer
26. A willful act by an employee of taking possession of an employer's money
Amblatory Care
abuse
privacy
Embezzlement
27. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
phantom billing
(TPA) Third Party Administrator
benefit period
(DME) Durable Medical Equipment
28. 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)
complience
(PEC) Pre-existing condition
authorization form
Consent form
29. The condition of being secluded from the presence or view of others.
Beneficiary
complience
privacy
IIHI
30. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
nonprivileged information
breach of confidential communication
disclosure
AMA
31. A willful act by an employee of taking possession of an employer's money
Embezzlement
ppo
premium
(DRG's)
32. Health Information Portability and Accountability Act
premium
electronic media
HIPAA
referral
33. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
Notice of Privacy Practices
ppo
hmo
Amblatory Care
34. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
(PEC) Pre-existing condition
clearinghouse
Covered Expenses
35. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Standard
(UR) Utilization review
ppo
IIHI
36. An organization of provider sites with a contracted relationship that offer services
covered entity
Privacy officer
ids
(OOPs) Out of Pocket Costs/Expenses
37. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
ids
subscriber
(DCI) Duplicate Coverage Inquiry
38. 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.
Out of Network (OON)
Network
epo
security officer
39. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Embezzlement
ordering physician
Assignment & Authorization
Supplementary Medical Insurance
40. An intentional misrepresentation of the facts to deceive or mislead another.
Consent form
(ABN) Advance Beneficiary Notice
Supplementary Medical Insurance
fraud
41. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
fraud
phantom billing
(ERISA) Employee Retirement Income Security Act of 1974
42. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
referring physician
nonprivileged information
(DCI) Duplicate Coverage Inquiry
electronic media
43. A patient claim is eligible for medicare and medicaid
medical foundation
crossover claim
Resonable Charge
(PAC) Pre- Admission Certification
44. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Experimental Procedures
(UCR) Usual - Customary and Reasonable
AMA
45. Health Information Portability and Accountability Act
Claim
Privacy officer
Pre-existing Condition Exclusion
HIPAA
46. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
crossover claim
(EPO) Exclusive Provider Organization
pcp
hmo
47. 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
(AOB) Assignment of Benefits
consent
IIHI
48. 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
Deductible
Protected health information
attending physician
(EPO) Exclusive Provider Organization
49. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Participating Provider
Pre-certification
Supplementary Medical Insurance
authorization form
50. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
ethics
econdary Payer
Referral