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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. 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
(COB) Coordination of Benefits
Open Enrollment
abuse
referring physician
2. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Maximum Out Of Pocket
Subscriber
fraud
(PPS) Hospital Impatient Prospective Payment System
3. An organization of provider sites with a contracted relationship that offer services
(PEC) Pre-existing condition
(AOB) Assignment of Benefits
ids
nonprivileged information
4. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Security Rule
health care provider
Deductible
5. A nonprofit integrated delivery system
business associate
ee schedule
Preauthorization
medical foundation
6. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
Pre-existing Condition Exclusion
Subscriber
consulting physician
7. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
crossover claim
(AOB) Assignment of Benefits
cash flow
8. 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
Embezzlement
(DME) Durable Medical Equipment
ids
Embezzlement
9. A privileged communication that may be disclosed only with the patient's permission.
preauthorization
Confidential communication
Security Rule
referral
10. Someone who is eligible for or receiving benefits under an insurance policy or plan
Pre-existing Condition Exclusion
(TPA) Third Party Administrator
electronic media
Beneficiary
11. Billing for services not performed
(PCP) Primary Care Physician
ppo
phantom billing
medical foundation
12. A rule - condition - or requirement
crossover claim
Standard
breach of confidential communication
e-health information management
13. Health Information Portability and Accountability Act
HIPAA
Security Rule
open panel HMO
confidentiality
14. 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
Pre-existing Condition Exclusion
AMA
Specialist
(ERISA) Employee Retirement Income Security Act of 1974
15. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Deductible
Resonable Charge
electronic media
16. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
deductible
Pre-certification
consent
17. Billing for services not performed
electronic media
Standard
phantom billing
complience plan
18. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
nonprivileged information
Allowed Expenses
authorization form
19. 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
(DCI) Duplicate Coverage Inquiry
Supplementary Medical Insurance
Network
Assignment & Authorization
20. 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
Pre-existing Condition Exclusion
privacy
(APC) Ambulatory Patient Classifications
(ERISA) Employee Retirement Income Security Act of 1974
21. A health insurance enrollee chooses to see an out of network provider without authorization
confidentiality
e-health information management
self-referral
Claim
22. 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
(PPS) Hospital Impatient Prospective Payment System
(POS) Point-of Service Plan
Embezzlement
(PPS) Hospital Impatient Prospective Payment System
23. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Treating or performing physician
(PAC) Pre- Admission Certification
Pre-certification
hmo
24. 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.
Privileged information
privacy
Protected health information
attending physician
25. 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)
ppo
Subscriber
disclosure
26. Unauthorized release of information
breach of confidential communication
Network
(PPS) Hospital Impatient Prospective Payment System
subscriber
27. 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
cash flow
authorization form
breach of confidential communication
epo
28. Individually identifiable health information
ids
IIHI
Amblatory Care
crossover claim
29. A patient claim is eligible for medicare and medicaid
Amblatory Care
confidentiality
crossover claim
(PPS) Hospital Impatient Prospective Payment System
30. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured
AMA
Standard
(AOB) Assignment of Benefits
health care provider
31. An intentional misrepresentation of the facts to deceive or mislead another.
Participating Provider
claim
fraud
consent
32. 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
econdary Payer
breach of confidential communication
etiquette
(PCN) Primary Care Network
33. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
(ABN) Advance Beneficiary Notice
nonprivileged information
Individually identifiable health information
34. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
ordering physician
ethics
Specialist
Referral
35. 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
medical foundation
etiquette
transaction
36. The dates of healthcare services were provided to the beneficiary
Consent form
(DOS) Date of Service
IIHI
complience
37. 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.
covered entity
e-health information management
Protected health information
Notice of Privacy Practices
38. 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
health care provider
Maximum Out Of Pocket
pcp
Medigap Insurance
39. Medicare's method of paying acute care hospitals for inpatient care
crossover claim
(PEC) Pre-existing condition
(PPS) Hospital Impatient Prospective Payment System
breach of confidential communication
40. 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
Embezzlement
(APC) Ambulatory Patient Classifications
complience plan
41. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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42. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
covered entity
Individually identifiable health information
Coordinated Coverage
consulting physician
43. 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
(TPA) Third Party Administrator
etiquette
IIHI
authorization form
44. 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.
health care provider
(APC) Ambulatory Patient Classifications
Privacy officer
business associate
45. Is the provider who renders a service to a patient
nonprivileged information
Treating or performing physician
(APC) Ambulatory Patient Classifications
health care provider
46. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Supplementary Medical Insurance
transaction
ids
abuse
47. 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
Treating or performing physician
ppo
preauthorization
pcp
48. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(COB) Coordination of Benefits
Amblatory Care
(EPO) Exclusive Provider Organization
Maximum Out Of Pocket
49. 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
confidentiality
Beneficiary
Allowed Expenses
50. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Privacy officer
Claim
health care provider
business associate