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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 monthly fee paid by the insured for specific medical insurance coverage
premium
Privacy officer
Maximum Out Of Pocket
attending physician
2. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
IIHI
state preemption
disclosure
Participating Provider
3. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
preauthorization
(ERISA) Employee Retirement Income Security Act of 1974
electronic media
4. A provision that apples when a person is covered under more than one group medical program
(PPS) Hospital Impatient Prospective Payment System
Pre-certification
business associate
(COB) Coordination of Benefits
5. Medicare's method of paying acute care hospitals for inpatient care
claim
epo
breach of confidential communication
(PPS) Hospital Impatient Prospective Payment System
6. Standards of conduct generally accepted as a moral guide for behavior.
ee schedule
(ERISA) Employee Retirement Income Security Act of 1974
clearinghouse
ethics
7. 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
e-health information management
complience plan
(COBRA)
pos
8. 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
etiquette
Preauthorization
referring physician
(PCN) Primary Care Network
9. What the insurance company will consider paying for as defined in the contract.
preauthorization
Covered Expenses
HIPAA
(AOB) Assignment of Benefits
10. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(PCP) Primary Care Physician
Claim
ordering physician
fraud
11. The amount of actual money available to the medical practice
Covered Expenses
fraud
cash flow
disclosure
12. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Subscriber
(PCN) Primary Care Network
(DCI) Duplicate Coverage Inquiry
e-health information management
13. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Covered Expenses
(DRG's)
Privileged information
14. 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.
ppo
Privileged information
open panel HMO
Participating Provider
15. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(DME) Durable Medical Equipment
Maximum Out Of Pocket
(PEC) Pre-existing condition
Specialist
16. 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
Individually identifiable health information
Experimental Procedures
(COB) Coordination of Benefits
17. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
confidentiality
Supplementary Medical Insurance
covered entity
18. 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
Coordinated Coverage
(PAC) Pre- Admission Certification
state preemption
(ERISA) Employee Retirement Income Security Act of 1974
19. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
HIPAA
Security Rule
Individually identifiable health information
20. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
referral
(POS) Point-of Service Plan
etiquette
21. 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.
(PAC) Pre- Admission Certification
health care provider
Treating or performing physician
Allowed Expenses
22. 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
complience plan
nonprivileged information
premium
Out of Network (OON)
23. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
cash flow
attending physician
referral
AMA
24. 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.
privacy
Open Enrollment
Protected health information
Open Enrollment
25. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
ee schedule
Privileged information
electronic media
claim
26. 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
Protected health information
Allowed Expenses
Sub-acute Care
Maximum Out Of Pocket
27. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Maximum Out Of Pocket
business associate
(TPA) Third Party Administrator
28. Unauthorized release of information
breach of confidential communication
Embezzlement
referring physician
Network
29. Customs - rules of conduct - courtesy - and manners of the medical profession
(POS) Point-of Service Plan
etiquette
(POS) Point-of Service Plan
ppo
30. Verbal or written agreement that gives approval to some action - situation - or statement.
covered entity
Maximum Out Of Pocket
security officer
consent
31. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Pre-existing Condition Exclusion
Network
(EPO) Exclusive Provider Organization
e-health information management
32. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
econdary Payer
authorization form
preauthorization
Amblatory Care
33. 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
self-referral
referring physician
AMA
(PCN) Primary Care Network
34. 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
ordering physician
(EPO) Exclusive Provider Organization
Security Rule
Protected health information
35. The dates of healthcare services were provided to the beneficiary
(AOB) Assignment of Benefits
Maximum Out Of Pocket
Specialist
(DOS) Date of Service
36. Individually identifiable health information
Specialist
ethics
IIHI
(ERISA) Employee Retirement Income Security Act of 1974
37. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Network
premium
Claim
38. A review of the need for inpatient hospital care - completed before the actual admission
self-referral
(PAC) Pre- Admission Certification
(DOS) Date of Service
disclosure
39. Is the provider who renders a service to a patient
Subscriber
premium
Treating or performing physician
abuse
40. A rule - condition - or requirement
Standard
Referral
(UCR) Usual - Customary and Reasonable
Embezzlement
41. A patient claim is eligible for medicare and medicaid
pos
hmo
crossover claim
(OOPs) Out of Pocket Costs/Expenses
42. Approval or consent by a primary physician for patient referral to ancillary services and specialists
disclosure
etiquette
Specialist
Referral
43. 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
Supplementary Medical Insurance
(UR) Utilization review
Deductible
Out of Network (OON)
44. 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.
benefit period
medical foundation
econdary Payer
security officer
45. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
complience plan
ppo
subscriber
e-health information management
46. Medical staff member who is legally responsible for the care and treatment given to a patient.
IIHI
ordering physician
Medigap Insurance
attending physician
47. Health Information Portability and Accountability Act
clearinghouse
HIPAA
Out of Network (OON)
(PCN) Primary Care Network
48. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
closed panel HMO
Specialist
attending physician
complience
49. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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50. An organization of provider sites with a contracted relationship that offer services
state preemption
ids
Covered Expenses
premium