SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
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 notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Notice of Privacy Practices
hmo
Claim
Protected health information
2. A patient claim is eligible for medicare and medicaid
e-health information management
Individually identifiable health information
(EPO) Exclusive Provider Organization
crossover claim
3. Medicare's method of paying acute care hospitals for inpatient care
subscriber
(PAC) Pre- Admission Certification
(PPS) Hospital Impatient Prospective Payment System
medical foundation
4. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(Non-par) Non-Participating Provider
(DOS) Date of Service
open panel HMO
(UR) Utilization review
5. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Preauthorization
Allowed Expenses
complience plan
Pre-certification
6. 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
Security Rule
pos
electronic media
(AOB) Assignment of Benefits
7. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
transaction
Specialist
deductible
8. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
covered entity
complience
AMA
9. 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
Supplementary Medical Insurance
(PPS) Hospital Impatient Prospective Payment System
Consent form
e-health information management
10. 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.
Standard
ids
security officer
IIHI
11. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Maximum Out Of Pocket
Deductible
(UCR) Usual - Customary and Reasonable
ordering physician
12. 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
Network
Pre-certification
Consent form
Out of Network (OON)
13. The period of time that payment for Medicare inpatient hospital benefits are available
(PEC) Pre-existing condition
self-referral
state preemption
benefit period
14. A monthly fee paid by the insured for specific medical insurance coverage
premium
ids
(TPA) Third Party Administrator
complience
15. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
covered entity
Preauthorization
Confidential communication
16. 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
Referral
Experimental Procedures
Participating Provider
deductible
17. 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
(AOB) Assignment of Benefits
Medigap Insurance
Security Rule
(ERISA) Employee Retirement Income Security Act of 1974
18. Integrating benefits payable under more than one health insurance.
authorization form
Coordinated Coverage
Privacy officer
(ABN) Advance Beneficiary Notice
19. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Confidential communication
(DRG's)
complience
Claim
20. 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
closed panel HMO
phantom billing
Claim
21. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Deductible
IIHI
(OOPs) Out of Pocket Costs/Expenses
(PEC) Pre-existing condition
22. 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
Embezzlement
(DME) Durable Medical Equipment
security officer
(ERISA) Employee Retirement Income Security Act of 1974
23. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
hmo
(PEC) Pre-existing condition
ee schedule
Covered Expenses
24. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
covered entity
consulting physician
deductible
Standard
25. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(ABN) Advance Beneficiary Notice
Notice of Privacy Practices
Individually identifiable health information
preauthorization
26. 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
open panel HMO
(PCP) Primary Care Physician
(PEC) Pre-existing condition
epo
27. 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
preauthorization
pos
referral
security officer
28. The maximum amount a plan pays for a covered service
abuse
(PAC) Pre- Admission Certification
Protected health information
Allowed Expenses
29. A nonprofit integrated delivery system
Participating Provider
medical foundation
(DOS) Date of Service
pos
30. Verbal or written agreement that gives approval to some action - situation - or statement.
econdary Payer
consent
(UCR) Usual - Customary and Reasonable
Pre-existing Condition Exclusion
31. A rule - condition - or requirement
Subscriber
(PPS) Hospital Impatient Prospective Payment System
complience plan
Standard
32. 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
Assignment & Authorization
(PEC) Pre-existing condition
Deductible
(TPA) Third Party Administrator
33. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Experimental Procedures
Allowed Expenses
ethics
deductible
34. 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
(OOPs) Out of Pocket Costs/Expenses
Treating or performing physician
confidentiality
35. Standards of conduct generally accepted as a moral guide for behavior.
(POS) Point-of Service Plan
ethics
self-referral
Network
36. Individually identifiable health information
Open Enrollment
econdary Payer
IIHI
consulting physician
37. 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
(PCN) Primary Care Network
referral
pos
38. A list of the amount to be paid by an insurance company for each procedure service
transaction
subscriber
ee schedule
medical foundation
39. An intentional misrepresentation of the facts to deceive or mislead another.
Privileged information
nonprivileged information
(DOS) Date of Service
fraud
40. 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
Allowed Expenses
open panel HMO
AMA
(COBRA)
41. Medical services provided on an outpatient basis
phantom billing
Amblatory Care
(Non-par) Non-Participating Provider
(ABN) Advance Beneficiary Notice
42. 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.
Security Rule
ids
(PCN) Primary Care Network
state preemption
43. 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
(PCN) Primary Care Network
benefit period
Amblatory Care
(PCP) Primary Care Physician
44. A health insurance enrollee chooses to see an out of network provider without authorization
fraud
preauthorization
self-referral
(PCN) Primary Care Network
45. 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
crossover claim
Resonable Charge
health care provider
Maximum Out Of Pocket
46. 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.
prepaid plan
deductible
Privacy officer
benefit period
47. Medical services provided on an outpatient basis
Preauthorization
(AOB) Assignment of Benefits
Amblatory Care
medical foundation
48. A patient claim is eligible for medicare and medicaid
health care provider
ethics
crossover claim
IIHI
49. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
AMA
Preauthorization
preauthorization
50. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
business associate
clearinghouse
(TPA) Third Party Administrator
Pre-certification