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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. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
(UCR) Usual - Customary and Reasonable
(UR) Utilization review
Medigap Insurance
2. 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.
Privacy officer
Protected health information
nonprivileged information
Out of Network (OON)
3. A privileged communication that may be disclosed only with the patient's permission.
fraud
consulting physician
covered entity
Confidential communication
4. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Privileged information
Beneficiary
Pre-certification
(PCP) Primary Care Physician
5. 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
benefit period
(DCI) Duplicate Coverage Inquiry
Out of Network (OON)
(OOPs) Out of Pocket Costs/Expenses
6. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
confidentiality
(PEC) Pre-existing condition
referring physician
premium
7. 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
epo
(UCR) Usual - Customary and Reasonable
confidentiality
business associate
8. A list of the amount to be paid by an insurance company for each procedure service
IIHI
ee schedule
Assignment & Authorization
covered entity
9. 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
privacy
abuse
epo
Network
10. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
confidentiality
Coordinated Coverage
business associate
referral
11. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou
Sub-acute Care
prepaid plan
Open Enrollment
phantom billing
12. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
security officer
Covered Expenses
Pre-existing Condition Exclusion
hmo
13. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
premium
Beneficiary
e-health information management
confidentiality
14. 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
premium
crossover claim
Pre-certification
15. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Specialist
pos
clearinghouse
(DCI) Duplicate Coverage Inquiry
16. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
abuse
(AOB) Assignment of Benefits
closed panel HMO
17. 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
Confidential communication
Assignment & Authorization
econdary Payer
epo
18. 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
(POS) Point-of Service Plan
Coordinated Coverage
Out of Network (OON)
19. A structure for classifying outpatient services and procedures for purpose of payment
pos
Coordinated Coverage
abuse
(APC) Ambulatory Patient Classifications
20. Approval or consent by a primary physician for patient referral to ancillary services and specialists
complience
(PCN) Primary Care Network
epo
Referral
21. 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
phantom billing
disclosure
Deductible
(POS) Point-of Service Plan
22. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Assignment & Authorization
(ERISA) Employee Retirement Income Security Act of 1974
hmo
Specialist
23. What the insurance company will consider paying for as defined in the contract.
(PCP) Primary Care Physician
(APC) Ambulatory Patient Classifications
Covered Expenses
consent
24. 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
crossover claim
pos
Out of Network (OON)
security officer
25. 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.
etiquette
business associate
Notice of Privacy Practices
open panel HMO
26. Unauthorized release of information
Amblatory Care
health care provider
Embezzlement
breach of confidential communication
27. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
consent
Medigap Insurance
attending physician
Network
28. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
nonprivileged information
(PCN) Primary Care Network
Amblatory Care
(UR) Utilization review
29. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
Out of Network (OON)
Privileged information
Participating Provider
ethics
30. What the insurance company will consider paying for as defined in the contract.
Beneficiary
business associate
transaction
Covered Expenses
31. 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
(COBRA)
Deductible
Preauthorization
(POS) Point-of Service Plan
32. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
closed panel HMO
epo
etiquette
confidentiality
33. Customs - rules of conduct - courtesy - and manners of the medical profession
AMA
etiquette
transaction
(TPA) Third Party Administrator
34. 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.
ids
(PCN) Primary Care Network
health care provider
Consent form
35. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Referral
(COBRA)
consulting physician
Sub-acute Care
36. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
Protected health information
subscriber
(PEC) Pre-existing condition
37. A provision that apples when a person is covered under more than one group medical program
subscriber
abuse
(COB) Coordination of Benefits
open panel HMO
38. Customs - rules of conduct - courtesy - and manners of the medical profession
consent
etiquette
Experimental Procedures
Pre-certification
39. 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.
closed panel HMO
Confidential communication
Notice of Privacy Practices
closed panel HMO
40. 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
Allowed Expenses
HIPAA
Participating Provider
41. 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
(PCP) Primary Care Physician
econdary Payer
complience
(ERISA) Employee Retirement Income Security Act of 1974
42. 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.
attending physician
Sub-acute Care
(DCI) Duplicate Coverage Inquiry
Protected health information
43. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(OOPs) Out of Pocket Costs/Expenses
(PAC) Pre- Admission Certification
Individually identifiable health information
(PCP) Primary Care Physician
44. An intentional misrepresentation of the facts to deceive or mislead another.
Protected health information
fraud
e-health information management
epo
45. American Medical Association
Privileged information
Supplementary Medical Insurance
ids
AMA
46. Billing for services not performed
phantom billing
deductible
closed panel HMO
Experimental Procedures
47. 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
confidentiality
Experimental Procedures
Out of Network (OON)
pcp
48. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
(DRG's)
ordering physician
Deductible
49. 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
Resonable Charge
covered entity
AMA
(PPS) Hospital Impatient Prospective Payment System
50. An organization of provider sites with a contracted relationship that offer services
(PCP) Primary Care Physician
ids
open panel HMO
Security Rule