SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(COB) Coordination of Benefits
(UR) Utilization review
preauthorization
Allowed Expenses
2. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(POS) Point-of Service Plan
consulting physician
Assignment & Authorization
(PCN) Primary Care Network
3. 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
Assignment & Authorization
open panel HMO
Embezzlement
4. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
(DOS) Date of Service
(ERISA) Employee Retirement Income Security Act of 1974
phantom billing
5. A monthly fee paid by the insured for specific medical insurance coverage
authorization form
Consent form
Pre-existing Condition Exclusion
premium
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)
Consent form
prepaid plan
health care provider
ids
7. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Open Enrollment
referring physician
Protected health information
8. 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.
breach of confidential communication
Pre-existing Condition Exclusion
subscriber
Privacy officer
9. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
(OOPs) Out of Pocket Costs/Expenses
Resonable Charge
fraud
10. 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.
breach of confidential communication
business associate
(ERISA) Employee Retirement Income Security Act of 1974
cash flow
11. 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
Out of Network (OON)
Medigap Insurance
Resonable Charge
Participating Provider
12. A monthly fee paid by the insured for specific medical insurance coverage
(PEC) Pre-existing condition
(COB) Coordination of Benefits
premium
Privileged information
13. A rule - condition - or requirement
consulting physician
AMA
Notice of Privacy Practices
Standard
14. Is the provider who renders a service to a patient
Experimental Procedures
AMA
referral
Treating or performing physician
15. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
electronic media
deductible
(EPO) Exclusive Provider Organization
Notice of Privacy Practices
16. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
complience
Preauthorization
ee schedule
17. 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.
Notice of Privacy Practices
(AOB) Assignment of Benefits
(PCP) Primary Care Physician
ee schedule
18. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
complience
Open Enrollment
ethics
19. 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
(DME) Durable Medical Equipment
Participating Provider
Subscriber
20. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
abuse
Notice of Privacy Practices
Experimental Procedures
21. 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
Security Rule
phantom billing
Out of Network (OON)
(PPS) Hospital Impatient Prospective Payment System
22. 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
(COB) Coordination of Benefits
claim
(PCN) Primary Care Network
23. 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
consulting physician
(Non-par) Non-Participating Provider
Network
benefit period
24. Someone who is eligible for or receiving benefits under an insurance policy or plan
Individually identifiable health information
Resonable Charge
Beneficiary
health care provider
25. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Embezzlement
consulting physician
AMA
26. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
(PPS) Hospital Impatient Prospective Payment System
AMA
privacy
27. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
hmo
Network
(APC) Ambulatory Patient Classifications
IIHI
28. 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
covered entity
Out of Network (OON)
benefit period
(DME) Durable Medical Equipment
29. An intentional misrepresentation of the facts to deceive or mislead another.
Preauthorization
fraud
Resonable Charge
phantom billing
30. 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
premium
pos
(DOS) Date of Service
Individually identifiable health information
31. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Amblatory Care
Out of Network (OON)
(EPO) Exclusive Provider Organization
(OOPs) Out of Pocket Costs/Expenses
32. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Treating or performing physician
Treating or performing physician
pcp
Privileged information
33. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Supplementary Medical Insurance
econdary Payer
Subscriber
Standard
34. 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.
referring physician
Open Enrollment
security officer
AMA
35. A patient claim is eligible for medicare and medicaid
(PCN) Primary Care Network
crossover claim
Network
ids
36. 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
Assignment & Authorization
(Non-par) Non-Participating Provider
self-referral
(ABN) Advance Beneficiary Notice
37. The amount of actual money available to the medical practice
cash flow
consent
Assignment & Authorization
premium
38. 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
pos
Medigap Insurance
(PAC) Pre- Admission Certification
Assignment & Authorization
39. A review of the need for inpatient hospital care - completed before the actual admission
Sub-acute Care
Resonable Charge
(PAC) Pre- Admission Certification
Consent form
40. 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.
AMA
business associate
self-referral
Preauthorization
41. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Security Rule
hmo
Open Enrollment
42. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Deductible
(DCI) Duplicate Coverage Inquiry
Pre-certification
HIPAA
43. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
transaction
Privacy officer
Covered Expenses
44. A patient claim is eligible for medicare and medicaid
crossover claim
Consent form
fraud
(PPS) Hospital Impatient Prospective Payment System
45. A provision that apples when a person is covered under more than one group medical program
pos
(UCR) Usual - Customary and Reasonable
(AOB) Assignment of Benefits
(COB) Coordination of Benefits
46. 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
business associate
Consent form
Supplementary Medical Insurance
open panel HMO
47. The maximum amount a plan pays for a covered service
Subscriber
Allowed Expenses
Maximum Out Of Pocket
Sub-acute Care
48. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Pre-certification
Subscriber
hmo
preauthorization
49. Unauthorized release of information
(PEC) Pre-existing condition
breach of confidential communication
state preemption
Deductible
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
(Non-par) Non-Participating Provider
Supplementary Medical Insurance
econdary Payer
etiquette