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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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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. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(PAC) Pre- Admission Certification
ordering physician
ids
Beneficiary
2. Verbal or written agreement that gives approval to some action - situation - or statement.
(PEC) Pre-existing condition
e-health information management
(UCR) Usual - Customary and Reasonable
consent
3. The period of time that payment for Medicare inpatient hospital benefits are available
Allowed Expenses
benefit period
ee schedule
(AOB) Assignment of Benefits
4. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
authorization form
ordering physician
disclosure
breach of confidential communication
5. 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
Consent form
health care provider
Out of Network (OON)
econdary Payer
6. 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
clearinghouse
claim
(ABN) Advance Beneficiary Notice
Protected health information
7. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
nonprivileged information
(EPO) Exclusive Provider Organization
etiquette
complience
8. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
medical foundation
Individually identifiable health information
Confidential communication
9. 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
Out of Network (OON)
confidentiality
Supplementary Medical Insurance
benefit period
10. 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
(AOB) Assignment of Benefits
(ABN) Advance Beneficiary Notice
Individually identifiable health information
Out of Network (OON)
11. 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
breach of confidential communication
Coordinated Coverage
ordering physician
12. 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
(Non-par) Non-Participating Provider
covered entity
Sub-acute Care
pcp
13. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
referral
econdary Payer
(TPA) Third Party Administrator
14. Health Information Portability and Accountability Act
(PEC) Pre-existing condition
Allowed Expenses
(COBRA)
HIPAA
15. 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.
(ABN) Advance Beneficiary Notice
Notice of Privacy Practices
(OOPs) Out of Pocket Costs/Expenses
e-health information management
16. Unauthorized release of information
breach of confidential communication
Consent form
(ABN) Advance Beneficiary Notice
(PAC) Pre- Admission Certification
17. 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
nonprivileged information
nonprivileged information
(PAC) Pre- Admission Certification
Preauthorization
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.
security officer
open panel HMO
(Non-par) Non-Participating Provider
prepaid plan
19. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Treating or performing physician
ee schedule
nonprivileged information
consulting physician
20. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
cash flow
Amblatory Care
(OOPs) Out of Pocket Costs/Expenses
transaction
21. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
benefit period
business associate
(UR) Utilization review
disclosure
22. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
etiquette
Standard
Claim
23. 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
prepaid plan
transaction
Supplementary Medical Insurance
nonprivileged information
24. 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
state preemption
(PCP) Primary Care Physician
pos
Specialist
25. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Maximum Out Of Pocket
premium
(POS) Point-of Service Plan
Referral
26. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
disclosure
(EPO) Exclusive Provider Organization
nonprivileged information
27. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
clearinghouse
prepaid plan
Subscriber
preauthorization
28. 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
authorization form
Notice of Privacy Practices
Beneficiary
Security Rule
29. 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
Amblatory Care
(POS) Point-of Service Plan
open panel HMO
Open Enrollment
30. Unauthorized release of information
deductible
Pre-existing Condition Exclusion
breach of confidential communication
hmo
31. The maximum amount a plan pays for a covered service
(TPA) Third Party Administrator
Out of Network (OON)
(DCI) Duplicate Coverage Inquiry
Allowed Expenses
32. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
pcp
e-health information management
(POS) Point-of Service Plan
Pre-existing Condition Exclusion
33. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
referring physician
open panel HMO
subscriber
34. Is the provider who renders a service to a patient
claim
Treating or performing physician
covered entity
Referral
35. A nonprofit integrated delivery system
ethics
medical foundation
Standard
ordering physician
36. 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
phantom billing
(AOB) Assignment of Benefits
Assignment & Authorization
37. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Supplementary Medical Insurance
Resonable Charge
transaction
complience
38. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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39. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
privacy
subscriber
(DRG's)
Embezzlement
40. An organization of provider sites with a contracted relationship that offer services
attending physician
ppo
medical foundation
ids
41. Medicare's method of paying acute care hospitals for inpatient care
pos
(PPS) Hospital Impatient Prospective Payment System
Beneficiary
Maximum Out Of Pocket
42. The condition of being secluded from the presence or view of others.
Privacy officer
authorization form
ordering physician
privacy
43. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Notice of Privacy Practices
deductible
Subscriber
medical foundation
44. 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
Experimental Procedures
(POS) Point-of Service Plan
HIPAA
Preauthorization
45. 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
Security Rule
consent
(ABN) Advance Beneficiary Notice
46. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Allowed Expenses
Network
Out of Network (OON)
47. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(POS) Point-of Service Plan
complience plan
covered entity
etiquette
48. An organization of provider sites with a contracted relationship that offer services
(TPA) Third Party Administrator
epo
state preemption
ids
49. Individually identifiable health information
referring physician
Open Enrollment
abuse
IIHI
50. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(EPO) Exclusive Provider Organization
Network
(UCR) Usual - Customary and Reasonable
complience
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