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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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.
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. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
Out of Network (OON)
Individually identifiable health information
covered entity
privacy
2. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
IIHI
(EPO) Exclusive Provider Organization
Pre-certification
Beneficiary
3. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
authorization form
ids
(POS) Point-of Service Plan
4. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PPS) Hospital Impatient Prospective Payment System
Resonable Charge
Pre-existing Condition Exclusion
transaction
5. 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
Medigap Insurance
epo
claim
Open Enrollment
6. 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)
(AOB) Assignment of Benefits
premium
Consent form
security officer
7. 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
premium
(Non-par) Non-Participating Provider
attending physician
8. 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
crossover claim
e-health information management
Claim
pos
9. A monthly fee paid by the insured for specific medical insurance coverage
Referral
complience
subscriber
premium
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
Deductible
ee schedule
(PCP) Primary Care Physician
transaction
11. Health Information Portability and Accountability Act
HIPAA
Embezzlement
Standard
Subscriber
12. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(Non-par) Non-Participating Provider
(DME) Durable Medical Equipment
(PEC) Pre-existing condition
medical foundation
13. Is the provider who renders a service to a patient
Confidential communication
(UR) Utilization review
IIHI
Treating or performing physician
14. 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
Individually identifiable health information
Security Rule
ordering physician
Resonable Charge
15. 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
Standard
(PPS) Hospital Impatient Prospective Payment System
Specialist
(COBRA)
16. A clinic that is owned by the HMO and the physicians are employees of the HMO
(COBRA)
closed panel HMO
Protected health information
privacy
17. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
open panel HMO
Subscriber
deductible
ppo
18. 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
HIPAA
Claim
security officer
econdary Payer
19. 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.
Pre-certification
(COBRA)
Notice of Privacy Practices
authorization form
20. A health insurance enrollee chooses to see an out of network provider without authorization
(EPO) Exclusive Provider Organization
self-referral
(APC) Ambulatory Patient Classifications
Confidential communication
21. Customs - rules of conduct - courtesy - and manners of the medical profession
authorization form
(ERISA) Employee Retirement Income Security Act of 1974
etiquette
breach of confidential communication
22. 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
pos
Consent form
(PCN) Primary Care Network
covered entity
23. 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
Preauthorization
Sub-acute Care
IIHI
24. A rule - condition - or requirement
(ERISA) Employee Retirement Income Security Act of 1974
state preemption
cash flow
Standard
25. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
pcp
etiquette
Coordinated Coverage
26. 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
Embezzlement
(POS) Point-of Service Plan
closed panel HMO
(TPA) Third Party Administrator
27. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Protected health information
Coordinated Coverage
(DCI) Duplicate Coverage Inquiry
Covered Expenses
28. 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
(ERISA) Employee Retirement Income Security Act of 1974
attending physician
epo
nonprivileged information
29. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
(DRG's)
ethics
cash flow
30. A provision that apples when a person is covered under more than one group medical program
self-referral
Confidential communication
Notice of Privacy Practices
(COB) Coordination of Benefits
31. A patient claim is eligible for medicare and medicaid
crossover claim
(DRG's)
privacy
Maximum Out Of Pocket
32. Health Information Portability and Accountability Act
(EPO) Exclusive Provider Organization
Pre-certification
pos
HIPAA
33. Standards of conduct generally accepted as a moral guide for behavior.
e-health information management
(PPS) Hospital Impatient Prospective Payment System
ethics
nonprivileged information
34. American Medical Association
Covered Expenses
Coordinated Coverage
AMA
referral
35. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
Medigap Insurance
consulting physician
security officer
36. A willful act by an employee of taking possession of an employer's money
(DCI) Duplicate Coverage Inquiry
Embezzlement
(COB) Coordination of Benefits
Treating or performing physician
37. A monthly fee paid by the insured for specific medical insurance coverage
premium
cash flow
consent
Open Enrollment
38. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(DRG's)
pos
subscriber
business associate
39. An intentional misrepresentation of the facts to deceive or mislead another.
Embezzlement
ordering physician
fraud
Participating Provider
40. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
security officer
prepaid plan
Embezzlement
41. Customs - rules of conduct - courtesy - and manners of the medical profession
HIPAA
attending physician
(PCN) Primary Care Network
etiquette
42. The condition of being secluded from the presence or view of others.
referral
consulting physician
privacy
(ERISA) Employee Retirement Income Security Act of 1974
43. Unauthorized release of information
breach of confidential communication
(POS) Point-of Service Plan
hmo
Participating Provider
44. The dates of healthcare services were provided to the beneficiary
Privacy officer
privacy
(DOS) Date of Service
Security Rule
45. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(COB) Coordination of Benefits
referring physician
Resonable Charge
electronic media
46. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
self-referral
security officer
Resonable Charge
47. Someone who is eligible for or receiving benefits under an insurance policy or plan
Sub-acute Care
(PCN) Primary Care Network
Beneficiary
state preemption
48. A patient claim is eligible for medicare and medicaid
crossover claim
fraud
(POS) Point-of Service Plan
benefit period
49. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
consulting physician
(UR) Utilization review
(APC) Ambulatory Patient Classifications
(OOPs) Out of Pocket Costs/Expenses
50. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
epo
Consent form
Assignment & Authorization
abuse