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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. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(APC) Ambulatory Patient Classifications
disclosure
Participating Provider
(PCN) Primary Care Network
2. A privileged communication that may be disclosed only with the patient's permission.
Sub-acute Care
(PAC) Pre- Admission Certification
Confidential communication
Participating Provider
3. 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.
Protected health information
etiquette
Experimental Procedures
(DOS) Date of Service
4. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
clearinghouse
Specialist
claim
transaction
5. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Protected health information
transaction
Deductible
benefit period
6. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
referral
Resonable Charge
pcp
crossover claim
7. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
referring physician
Specialist
(DCI) Duplicate Coverage Inquiry
business associate
8. A patient claim is eligible for medicare and medicaid
(AOB) Assignment of Benefits
crossover claim
closed panel HMO
security officer
9. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Referral
abuse
Pre-certification
Standard
10. 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
ppo
complience
(PPS) Hospital Impatient Prospective Payment System
prepaid plan
11. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
(APC) Ambulatory Patient Classifications
Protected health information
confidentiality
12. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Sub-acute Care
hmo
Consent form
ordering physician
13. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
Network
Out of Network (OON)
(COB) Coordination of Benefits
14. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
etiquette
(OOPs) Out of Pocket Costs/Expenses
Resonable Charge
15. 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
Deductible
consulting physician
(ABN) Advance Beneficiary Notice
Participating Provider
16. 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
Pre-existing Condition Exclusion
Security Rule
closed panel HMO
transaction
17. 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
ids
Amblatory Care
IIHI
ppo
18. 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
Supplementary Medical Insurance
Confidential communication
Preauthorization
covered entity
19. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
Network
Individually identifiable health information
attending physician
20. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(UCR) Usual - Customary and Reasonable
IIHI
business associate
(PEC) Pre-existing condition
21. 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.
abuse
pcp
Open Enrollment
business associate
22. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(PEC) Pre-existing condition
Assignment & Authorization
(OOPs) Out of Pocket Costs/Expenses
(DRG's)
23. 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
Subscriber
(COBRA)
cash flow
Standard
24. A rule - condition - or requirement
Beneficiary
Out of Network (OON)
Amblatory Care
Standard
25. The transmission of information between two parties to carry out financial or administrative activities related to health care.
prepaid plan
Covered Expenses
transaction
cash flow
26. 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
(DRG's)
business associate
Supplementary Medical Insurance
Privileged information
27. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Deductible
Covered Expenses
consulting physician
preauthorization
28. 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
Embezzlement
Medigap Insurance
Pre-certification
Participating Provider
29. The period of time that payment for Medicare inpatient hospital benefits are available
(Non-par) Non-Participating Provider
benefit period
Claim
state preemption
30. 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
(ABN) Advance Beneficiary Notice
prepaid plan
(COBRA)
health care provider
31. 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)
Confidential communication
open panel HMO
transaction
Consent form
32. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
security officer
abuse
(DOS) Date of Service
Treating or performing physician
33. Health Information Portability and Accountability Act
Maximum Out Of Pocket
HIPAA
pos
(AOB) Assignment of Benefits
34. A privileged communication that may be disclosed only with the patient's permission.
health care provider
(APC) Ambulatory Patient Classifications
(DME) Durable Medical Equipment
Confidential communication
35. A health insurance enrollee chooses to see an out of network provider without authorization
Pre-existing Condition Exclusion
self-referral
Security Rule
(EPO) Exclusive Provider Organization
36. A nonprofit integrated delivery system
referring physician
Subscriber
(DOS) Date of Service
medical foundation
37. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
crossover claim
(DME) Durable Medical Equipment
Experimental Procedures
38. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
(PAC) Pre- Admission Certification
ethics
(DRG's)
39. American Medical Association
fraud
Sub-acute Care
AMA
(POS) Point-of Service Plan
40. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Privacy officer
ppo
confidentiality
Amblatory Care
41. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Referral
covered entity
Experimental Procedures
claim
42. The dates of healthcare services were provided to the beneficiary
breach of confidential communication
Embezzlement
ordering physician
(DOS) Date of Service
43. 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
benefit period
Privacy officer
Experimental Procedures
pos
44. A patient claim is eligible for medicare and medicaid
(DCI) Duplicate Coverage Inquiry
health care provider
crossover claim
consent
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
Confidential communication
closed panel HMO
Resonable Charge
(PCN) Primary Care Network
46. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Referral
pcp
Preauthorization
(POS) Point-of Service Plan
47. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(DRG's)
Protected health information
phantom billing
(OOPs) Out of Pocket Costs/Expenses
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
HIPAA
referring physician
HIPAA
Deductible
49. 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
preauthorization
Maximum Out Of Pocket
Experimental Procedures
ppo
50. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
security officer
Privacy officer
(TPA) Third Party Administrator
clearinghouse