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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. An organization of provider sites with a contracted relationship that offer services
Subscriber
Coordinated Coverage
ids
Covered Expenses
2. The condition of being secluded from the presence or view of others.
(COBRA)
privacy
attending physician
breach of confidential communication
3. The amount of actual money available to the medical practice
privacy
(PAC) Pre- Admission Certification
(Non-par) Non-Participating Provider
cash flow
4. Medical services provided on an outpatient basis
Amblatory Care
state preemption
prepaid plan
complience
5. Is a provider who sends the patients for testing or treatment
referring physician
security officer
Specialist
(OOPs) Out of Pocket Costs/Expenses
6. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(PAC) Pre- Admission Certification
Beneficiary
e-health information management
(ABN) Advance Beneficiary Notice
7. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
Deductible
disclosure
closed panel HMO
8. Standards of conduct generally accepted as a moral guide for behavior.
Covered Expenses
(DME) Durable Medical Equipment
health care provider
ethics
9. 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
ids
self-referral
pos
AMA
10. Standards of conduct generally accepted as a moral guide for behavior.
ethics
HIPAA
phantom billing
Notice of Privacy Practices
11. Verbal or written agreement that gives approval to some action - situation - or statement.
Sub-acute Care
Privacy officer
fraud
consent
12. A review of the need for inpatient hospital care - completed before the actual admission
Sub-acute Care
Network
Specialist
(PAC) Pre- Admission Certification
13. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)
Privacy officer
Consent form
(ABN) Advance Beneficiary Notice
(UCR) Usual - Customary and Reasonable
14. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Experimental Procedures
Out of Network (OON)
ordering physician
nonprivileged information
15. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
covered entity
prepaid plan
hmo
epo
16. 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
medical foundation
Embezzlement
(DCI) Duplicate Coverage Inquiry
17. 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
(DRG's)
Standard
premium
nonprivileged information
18. The condition of being secluded from the presence or view of others.
complience plan
privacy
ordering physician
phantom billing
19. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
(ABN) Advance Beneficiary Notice
e-health information management
premium
20. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured
(AOB) Assignment of Benefits
phantom billing
Privileged information
subscriber
21. 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.
health care provider
ppo
consulting physician
business associate
22. 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
self-referral
preauthorization
electronic media
authorization form
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
HIPAA
closed panel HMO
econdary Payer
disclosure
24. 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
epo
Privileged information
benefit period
Assignment & Authorization
25. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)
Consent form
(DCI) Duplicate Coverage Inquiry
(APC) Ambulatory Patient Classifications
crossover claim
26. 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
pcp
Privacy officer
covered entity
epo
27. A willful act by an employee of taking possession of an employer's money
ee schedule
Embezzlement
disclosure
(PCN) Primary Care Network
28. A clinic that is owned by the HMO and the physicians are employees of the HMO
(PEC) Pre-existing condition
(ABN) Advance Beneficiary Notice
closed panel HMO
Individually identifiable health information
29. Customs - rules of conduct - courtesy - and manners of the medical profession
business associate
Consent form
etiquette
(COBRA)
30. Medicare's method of paying acute care hospitals for inpatient care
disclosure
etiquette
(PPS) Hospital Impatient Prospective Payment System
Standard
31. 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
Pre-existing Condition Exclusion
(ABN) Advance Beneficiary Notice
Participating Provider
crossover claim
32. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Amblatory Care
(OOPs) Out of Pocket Costs/Expenses
state preemption
Confidential communication
33. 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
crossover claim
Treating or performing physician
Security Rule
34. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Protected health information
Embezzlement
(DME) Durable Medical Equipment
(DCI) Duplicate Coverage Inquiry
35. Someone who is eligible for or receiving benefits under an insurance policy or plan
Coordinated Coverage
Beneficiary
(UR) Utilization review
Consent form
36. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
complience
Privacy officer
(APC) Ambulatory Patient Classifications
37. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated
Pre-existing Condition Exclusion
referral
electronic media
Resonable Charge
38. 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
(ABN) Advance Beneficiary Notice
self-referral
Supplementary Medical Insurance
Out of Network (OON)
39. 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
(PPS) Hospital Impatient Prospective Payment System
(Non-par) Non-Participating Provider
authorization form
Out of Network (OON)
40. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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41. 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
HIPAA
electronic media
Experimental Procedures
Preauthorization
42. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
ppo
Referral
Resonable Charge
43. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Privacy officer
e-health information management
Claim
referring physician
44. A review of the need for inpatient hospital care - completed before the actual admission
Privileged information
covered entity
(PAC) Pre- Admission Certification
Preauthorization
45. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan
Participating Provider
Standard
Consent form
e-health information management
46. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
hmo
referral
electronic media
ids
47. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Pre-existing Condition Exclusion
confidentiality
Deductible
Out of Network (OON)
48. 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.
(AOB) Assignment of Benefits
Pre-certification
open panel HMO
state preemption
49. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pos
Coordinated Coverage
pcp
IIHI
50. A clinic that is owned by the HMO and the physicians are employees of the HMO
(COB) Coordination of Benefits
security officer
closed panel HMO
benefit period