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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 provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
security officer
(ERISA) Employee Retirement Income Security Act of 1974
ethics
consulting physician
2. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(APC) Ambulatory Patient Classifications
fraud
ppo
subscriber
3. 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
Individually identifiable health information
(DOS) Date of Service
electronic media
(Non-par) Non-Participating Provider
4. 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
closed panel HMO
(POS) Point-of Service Plan
(AOB) Assignment of Benefits
consent
5. Is the provider who renders a service to a patient
Treating or performing physician
(PEC) Pre-existing condition
AMA
Experimental Procedures
6. 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.
security officer
claim
Privileged information
Maximum Out Of Pocket
7. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
crossover claim
self-referral
Experimental Procedures
8. 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
breach of confidential communication
Sub-acute Care
(PCP) Primary Care Physician
(ABN) Advance Beneficiary Notice
9. 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
Assignment & Authorization
Protected health information
consent
Sub-acute Care
10. 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
ethics
Network
Coordinated Coverage
pos
11. Integrating benefits payable under more than one health insurance.
Privacy officer
Coordinated Coverage
privacy
Supplementary Medical Insurance
12. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
health care provider
(PCN) Primary Care Network
(APC) Ambulatory Patient Classifications
ordering physician
13. Medicare's method of paying acute care hospitals for inpatient care
Maximum Out Of Pocket
health care provider
(PPS) Hospital Impatient Prospective Payment System
privacy
14. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(TPA) Third Party Administrator
Supplementary Medical Insurance
Assignment & Authorization
Resonable Charge
15. 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.
(COBRA)
(DOS) Date of Service
health care provider
clearinghouse
16. A monthly fee paid by the insured for specific medical insurance coverage
premium
(PEC) Pre-existing condition
(DRG's)
Deductible
17. A provision that apples when a person is covered under more than one group medical program
health care provider
(TPA) Third Party Administrator
electronic media
(COB) Coordination of Benefits
18. An organization of provider sites with a contracted relationship that offer services
Out of Network (OON)
Referral
Specialist
ids
19. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Beneficiary
(COBRA)
(TPA) Third Party Administrator
complience plan
20. Billing for services not performed
phantom billing
Resonable Charge
HIPAA
e-health information management
21. Billing for services not performed
phantom billing
Assignment & Authorization
(PEC) Pre-existing condition
consent
22. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Preauthorization
pcp
Covered Expenses
cash flow
23. 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
phantom billing
referring physician
Subscriber
24. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
complience plan
(DRG's)
epo
Network
25. 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
medical foundation
Deductible
ppo
complience
26. 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
IIHI
premium
(DME) Durable Medical Equipment
electronic media
27. 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
Confidential communication
(DCI) Duplicate Coverage Inquiry
authorization form
(PCN) Primary Care Network
28. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
Pre-existing Condition Exclusion
(PCN) Primary Care Network
open panel HMO
authorization form
29. 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
phantom billing
premium
(Non-par) Non-Participating Provider
Out of Network (OON)
30. 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
IIHI
(COBRA)
Pre-existing Condition Exclusion
deductible
31. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Sub-acute Care
nonprivileged information
ethics
subscriber
32. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Privacy officer
(DCI) Duplicate Coverage Inquiry
Individually identifiable health information
phantom billing
33. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations
consulting physician
(OOPs) Out of Pocket Costs/Expenses
authorization form
(POS) Point-of Service Plan
34. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
clearinghouse
subscriber
disclosure
Open Enrollment
35. Medical staff member who is legally responsible for the care and treatment given to a patient.
Resonable Charge
Referral
Pre-certification
attending physician
36. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(AOB) Assignment of Benefits
(UCR) Usual - Customary and Reasonable
Specialist
Open Enrollment
37. Individually identifiable health information
IIHI
(APC) Ambulatory Patient Classifications
Claim
state preemption
38. 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.
Consent form
Consent form
Privileged information
Claim
39. Customs - rules of conduct - courtesy - and manners of the medical profession
ids
Coordinated Coverage
etiquette
referral
40. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
clearinghouse
privacy
hmo
Pre-certification
41. 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
claim
confidentiality
epo
covered entity
42. 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.
authorization form
Preauthorization
business associate
Beneficiary
43. 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.
Individually identifiable health information
(PCP) Primary Care Physician
Notice of Privacy Practices
(ABN) Advance Beneficiary Notice
44. 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
premium
Experimental Procedures
(PAC) Pre- Admission Certification
consulting physician
45. 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
referral
closed panel HMO
Sub-acute Care
covered entity
46. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(POS) Point-of Service Plan
Claim
pos
Allowed Expenses
47. Is a provider who sends the patients for testing or treatment
(ABN) Advance Beneficiary Notice
covered entity
referring physician
(COB) Coordination of Benefits
48. 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.
Notice of Privacy Practices
consent
deductible
complience
49. American Medical Association
AMA
Standard
abuse
(ERISA) Employee Retirement Income Security Act of 1974
50. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
(UCR) Usual - Customary and Reasonable
state preemption
Confidential communication