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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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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. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage
Specialist
(COB) Coordination of Benefits
(PCP) Primary Care Physician
Protected health information
2. A rule - condition - or requirement
(PCP) Primary Care Physician
Medigap Insurance
Standard
Preauthorization
3. 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
Specialist
clearinghouse
abuse
(PCN) Primary Care Network
4. An intentional misrepresentation of the facts to deceive or mislead another.
HIPAA
Allowed Expenses
self-referral
fraud
5. 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
complience
(PPS) Hospital Impatient Prospective Payment System
Pre-certification
covered entity
6. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
ids
electronic media
IIHI
7. Approval or consent by a primary physician for patient referral to ancillary services and specialists
AMA
referring physician
Confidential communication
Referral
8. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
premium
(OOPs) Out of Pocket Costs/Expenses
electronic media
Privileged information
9. 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.
ordering physician
attending physician
closed panel HMO
security officer
10. An organization of provider sites with a contracted relationship that offer services
(PEC) Pre-existing condition
Open Enrollment
Coordinated Coverage
ids
11. 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
(UR) Utilization review
Supplementary Medical Insurance
claim
(ERISA) Employee Retirement Income Security Act of 1974
12. A structure for classifying outpatient services and procedures for purpose of payment
disclosure
(APC) Ambulatory Patient Classifications
(DCI) Duplicate Coverage Inquiry
crossover claim
13. 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
Sub-acute Care
epo
Security Rule
crossover claim
14. 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
state preemption
IIHI
Maximum Out Of Pocket
Deductible
15. Customs - rules of conduct - courtesy - and manners of the medical profession
clearinghouse
etiquette
claim
medical foundation
16. 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
(DOS) Date of Service
Experimental Procedures
ppo
17. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Privileged information
Participating Provider
(Non-par) Non-Participating Provider
confidentiality
18. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
phantom billing
Participating Provider
clearinghouse
e-health information management
19. Is a provider who sends the patients for testing or treatment
security officer
claim
referring physician
medical foundation
20. 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
(DME) Durable Medical Equipment
(OOPs) Out of Pocket Costs/Expenses
authorization form
complience
21. Individually identifiable health information
premium
Participating Provider
Security Rule
IIHI
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
Network
(COB) Coordination of Benefits
(POS) Point-of Service Plan
Supplementary Medical Insurance
23. 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
electronic media
covered entity
(EPO) Exclusive Provider Organization
Preauthorization
24. A monthly fee paid by the insured for specific medical insurance coverage
crossover claim
premium
(PEC) Pre-existing condition
econdary Payer
25. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Consent form
(POS) Point-of Service Plan
confidentiality
Resonable Charge
26. 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
premium
IIHI
Network
27. 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
complience
consulting physician
Preauthorization
(ABN) Advance Beneficiary Notice
28. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
crossover claim
(OOPs) Out of Pocket Costs/Expenses
fraud
29. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
cash flow
(OOPs) Out of Pocket Costs/Expenses
(COB) Coordination of Benefits
hmo
30. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
Open Enrollment
consulting physician
medical foundation
31. 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
health care provider
complience
open panel HMO
HIPAA
32. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
Experimental Procedures
Coordinated Coverage
Security Rule
(DME) Durable Medical Equipment
33. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
transaction
ids
deductible
claim
34. 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
(PAC) Pre- Admission Certification
Security Rule
epo
cash flow
35. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
Preauthorization
(PPS) Hospital Impatient Prospective Payment System
HIPAA
(PEC) Pre-existing condition
36. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Experimental Procedures
(AOB) Assignment of Benefits
(OOPs) Out of Pocket Costs/Expenses
Network
37. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
consent
deductible
Deductible
38. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Maximum Out Of Pocket
econdary Payer
referral
subscriber
39. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
confidentiality
hmo
Embezzlement
abuse
40. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
(DRG's)
security officer
Treating or performing physician
41. The dates of healthcare services were provided to the beneficiary
transaction
(DOS) Date of Service
privacy
complience plan
42. 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
Coordinated Coverage
clearinghouse
Security Rule
(PCN) Primary Care Network
43. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
electronic media
privacy
(UR) Utilization review
Beneficiary
44. 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
benefit period
Pre-existing Condition Exclusion
epo
45. 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
electronic media
Deductible
(DRG's)
(TPA) Third Party Administrator
46. Unauthorized release of information
prepaid plan
transaction
breach of confidential communication
crossover claim
47. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
(ERISA) Employee Retirement Income Security Act of 1974
subscriber
Protected health information
48. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
(ERISA) Employee Retirement Income Security Act of 1974
health care provider
abuse
49. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
ordering physician
pcp
covered entity
medical foundation
50. A provision that apples when a person is covered under more than one group medical program
ids
(COB) Coordination of Benefits
(OOPs) Out of Pocket Costs/Expenses
breach of confidential communication