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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. Is a provider who sends the patients for testing or treatment
(Non-par) Non-Participating Provider
referring physician
Amblatory Care
Referral
2. A willful act by an employee of taking possession of an employer's money
medical foundation
(OOPs) Out of Pocket Costs/Expenses
electronic media
Embezzlement
3. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
AMA
Preauthorization
(OOPs) Out of Pocket Costs/Expenses
Subscriber
4. Is the provider who renders a service to a patient
Treating or performing physician
Supplementary Medical Insurance
self-referral
(UR) Utilization review
5. 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
Sub-acute Care
cash flow
pcp
6. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.
health care provider
(DRG's)
Embezzlement
transaction
7. Medicare's method of paying acute care hospitals for inpatient care
consent
(ERISA) Employee Retirement Income Security Act of 1974
(PPS) Hospital Impatient Prospective Payment System
Standard
8. 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.
subscriber
Protected health information
nonprivileged information
ordering physician
9. Unauthorized release of information
(PCN) Primary Care Network
medical foundation
breach of confidential communication
Allowed Expenses
10. American Medical Association
abuse
(COB) Coordination of Benefits
preauthorization
AMA
11. 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
(ABN) Advance Beneficiary Notice
security officer
benefit period
subscriber
12. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(COBRA)
ordering physician
clearinghouse
pcp
13. 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
open panel HMO
benefit period
Sub-acute Care
prepaid plan
14. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(ABN) Advance Beneficiary Notice
referral
Out of Network (OON)
health care provider
15. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
open panel HMO
authorization form
Network
premium
16. Medical services provided on an outpatient basis
complience
health care provider
Amblatory Care
Notice of Privacy Practices
17. The condition of being secluded from the presence or view of others.
Privacy officer
preauthorization
(ABN) Advance Beneficiary Notice
privacy
18. Medical staff member who is legally responsible for the care and treatment given to a patient.
Experimental Procedures
Privacy officer
attending physician
Supplementary Medical Insurance
19. 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
(PCN) Primary Care Network
(ERISA) Employee Retirement Income Security Act of 1974
crossover claim
breach of confidential communication
20. 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
(POS) Point-of Service Plan
Individually identifiable health information
Open Enrollment
(DME) Durable Medical Equipment
21. 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
(COB) Coordination of Benefits
(PEC) Pre-existing condition
Preauthorization
22. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Referral
e-health information management
IIHI
breach of confidential communication
23. 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
abuse
Experimental Procedures
referral
Treating or performing physician
24. 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
Claim
attending physician
transaction
25. 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
pcp
covered entity
Individually identifiable health information
26. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
Individually identifiable health information
(AOB) Assignment of Benefits
ordering physician
27. Verbal or written agreement that gives approval to some action - situation - or statement.
(UR) Utilization review
Out of Network (OON)
consent
pos
28. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
abuse
medical foundation
health care provider
referral
29. What the insurance company will consider paying for as defined in the contract.
transaction
(DOS) Date of Service
Covered Expenses
privacy
30. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(PAC) Pre- Admission Certification
disclosure
(AOB) Assignment of Benefits
(OOPs) Out of Pocket Costs/Expenses
31. 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
pos
complience
transaction
business associate
32. 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
Deductible
Medigap Insurance
(PCP) Primary Care Physician
authorization form
33. 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
(OOPs) Out of Pocket Costs/Expenses
Protected health information
Subscriber
(DME) Durable Medical Equipment
34. A privileged communication that may be disclosed only with the patient's permission.
abuse
(DOS) Date of Service
(TPA) Third Party Administrator
Confidential communication
35. A structure for classifying outpatient services and procedures for purpose of payment
fraud
(TPA) Third Party Administrator
(APC) Ambulatory Patient Classifications
deductible
36. 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
AMA
attending physician
Beneficiary
(DME) Durable Medical Equipment
37. 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
Allowed Expenses
Out of Network (OON)
Subscriber
e-health information management
38. 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
(DCI) Duplicate Coverage Inquiry
preauthorization
epo
Notice of Privacy Practices
39. 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
pcp
crossover claim
(DOS) Date of Service
Out of Network (OON)
40. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
complience plan
ids
Deductible
41. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
clearinghouse
(PPS) Hospital Impatient Prospective Payment System
complience plan
Protected health information
42. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Preauthorization
Covered Expenses
business associate
43. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
fraud
ee schedule
(COBRA)
44. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Pre-existing Condition Exclusion
clearinghouse
Pre-existing Condition Exclusion
45. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
ee schedule
deductible
benefit period
Resonable Charge
46. 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.
(EPO) Exclusive Provider Organization
(POS) Point-of Service Plan
Sub-acute Care
security officer
47. 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
subscriber
(UR) Utilization review
pos
Supplementary Medical Insurance
48. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(TPA) Third Party Administrator
(Non-par) Non-Participating Provider
pcp
Medigap Insurance
49. Integrating benefits payable under more than one health insurance.
HIPAA
Coordinated Coverage
(AOB) Assignment of Benefits
econdary Payer
50. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Treating or performing physician
Claim
Preauthorization
AMA