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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 term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Confidential communication
Specialist
authorization form
(UCR) Usual - Customary and Reasonable
2. 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
(DRG's)
Preauthorization
cash flow
Network
3. Is a provider who sends the patients for testing or treatment
nonprivileged information
complience plan
Specialist
referring physician
4. Billing for services not performed
ppo
crossover claim
phantom billing
breach of confidential communication
5. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
e-health information management
hmo
Sub-acute Care
6. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
Experimental Procedures
complience plan
authorization form
econdary Payer
7. Standards of conduct generally accepted as a moral guide for behavior.
hmo
Deductible
premium
ethics
8. 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.
preauthorization
medical foundation
Deductible
Privileged information
9. 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
(DME) Durable Medical Equipment
Beneficiary
covered entity
ethics
10. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
econdary Payer
Deductible
(DOS) Date of Service
Notice of Privacy Practices
11. 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
(DME) Durable Medical Equipment
self-referral
Coordinated Coverage
Preauthorization
12. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Confidential communication
electronic media
Resonable Charge
authorization form
13. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Medigap Insurance
disclosure
Standard
Beneficiary
14. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Deductible
Protected health information
(UR) Utilization review
15. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Standard
(UCR) Usual - Customary and Reasonable
Open Enrollment
health care provider
16. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
ppo
health care provider
open panel HMO
17. 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
Privileged information
(DCI) Duplicate Coverage Inquiry
ee schedule
18. 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.
Open Enrollment
Covered Expenses
epo
security officer
19. Customs - rules of conduct - courtesy - and manners of the medical profession
(AOB) Assignment of Benefits
Resonable Charge
Network
etiquette
20. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(PCP) Primary Care Physician
abuse
Coordinated Coverage
Resonable Charge
21. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(DOS) Date of Service
(PCN) Primary Care Network
Network
Allowed Expenses
22. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Medigap Insurance
(AOB) Assignment of Benefits
Standard
Individually identifiable health information
23. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
preauthorization
(EPO) Exclusive Provider Organization
covered entity
Maximum Out Of Pocket
24. Verbal or written agreement that gives approval to some action - situation - or statement.
medical foundation
consent
e-health information management
fraud
25. A health insurance enrollee chooses to see an out of network provider without authorization
e-health information management
benefit period
Individually identifiable health information
self-referral
26. Is a provider who sends the patients for testing or treatment
referring physician
self-referral
(PEC) Pre-existing condition
Medigap Insurance
27. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
complience plan
Deductible
(TPA) Third Party Administrator
Participating Provider
28. The condition of being secluded from the presence or view of others.
(TPA) Third Party Administrator
Pre-certification
Individually identifiable health information
privacy
29. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Allowed Expenses
cash flow
Pre-existing Condition Exclusion
30. 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
ee schedule
(DME) Durable Medical Equipment
abuse
(POS) Point-of Service Plan
31. The maximum amount a plan pays for a covered service
abuse
Allowed Expenses
clearinghouse
claim
32. 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
(ABN) Advance Beneficiary Notice
cash flow
(POS) Point-of Service Plan
nonprivileged information
33. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Participating Provider
HIPAA
(PEC) Pre-existing condition
transaction
34. Medical services provided on an outpatient basis
Coordinated Coverage
breach of confidential communication
Amblatory Care
(EPO) Exclusive Provider Organization
35. 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.
HIPAA
health care provider
Out of Network (OON)
Deductible
36. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
(DRG's)
referring physician
(PEC) Pre-existing condition
37. 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
(APC) Ambulatory Patient Classifications
nonprivileged information
authorization form
Pre-existing Condition Exclusion
38. The condition of being secluded from the presence or view of others.
epo
(AOB) Assignment of Benefits
privacy
Network
39. 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
Maximum Out Of Pocket
Privileged information
Coordinated Coverage
(ERISA) Employee Retirement Income Security Act of 1974
40. 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.
(PPS) Hospital Impatient Prospective Payment System
business associate
pcp
Referral
41. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(PPS) Hospital Impatient Prospective Payment System
security officer
pcp
IIHI
42. 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
ethics
etiquette
breach of confidential communication
Sub-acute Care
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
Embezzlement
fraud
Specialist
pos
44. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
cash flow
Pre-certification
Beneficiary
(DCI) Duplicate Coverage Inquiry
45. 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
crossover claim
Allowed Expenses
state preemption
46. 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
Pre-existing Condition Exclusion
confidentiality
Amblatory Care
47. 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.
Privileged information
e-health information management
Out of Network (OON)
Open Enrollment
48. 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
prepaid plan
Network
(UCR) Usual - Customary and Reasonable
ethics
49. 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
ppo
Open Enrollment
phantom billing
(PEC) Pre-existing condition
50. 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
(PAC) Pre- Admission Certification
ethics
prepaid plan