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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. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(DME) Durable Medical Equipment
Medigap Insurance
hmo
2. Medical services provided on an outpatient basis
Treating or performing physician
Resonable Charge
(DCI) Duplicate Coverage Inquiry
Amblatory Care
3. What the insurance company will consider paying for as defined in the contract.
privacy
Covered Expenses
ethics
Supplementary Medical Insurance
4. 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
Claim
phantom billing
Out of Network (OON)
IIHI
5. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
closed panel HMO
ppo
crossover claim
(DCI) Duplicate Coverage Inquiry
6. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
(ABN) Advance Beneficiary Notice
pcp
covered entity
7. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
ee schedule
Open Enrollment
ppo
etiquette
8. 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
consulting physician
(EPO) Exclusive Provider Organization
(ABN) Advance Beneficiary Notice
benefit period
9. 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.
epo
disclosure
business associate
(ABN) Advance Beneficiary Notice
10. 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
authorization form
Allowed Expenses
Medigap Insurance
Maximum Out Of Pocket
11. 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
premium
ordering physician
Coordinated Coverage
12. 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
ethics
(COBRA)
Experimental Procedures
Medigap Insurance
13. 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
fraud
ordering physician
(OOPs) Out of Pocket Costs/Expenses
(Non-par) Non-Participating Provider
14. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
referring physician
preauthorization
attending physician
(OOPs) Out of Pocket Costs/Expenses
15. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
hmo
Privileged information
benefit period
16. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
Treating or performing physician
Allowed Expenses
Deductible
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
prepaid plan
business associate
health care provider
nonprivileged information
18. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Covered Expenses
(TPA) Third Party Administrator
(PCN) Primary Care Network
Referral
19. Billing for services not performed
Coordinated Coverage
Standard
Medigap Insurance
phantom billing
20. Verbal or written agreement that gives approval to some action - situation - or statement.
premium
Resonable Charge
HIPAA
consent
21. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
nonprivileged information
(DCI) Duplicate Coverage Inquiry
Specialist
breach of confidential communication
22. A privileged communication that may be disclosed only with the patient's permission.
health care provider
medical foundation
Confidential communication
(APC) Ambulatory Patient Classifications
23. 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.
epo
Participating Provider
(Non-par) Non-Participating Provider
Notice of Privacy Practices
24. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Individually identifiable health information
e-health information management
(POS) Point-of Service Plan
electronic media
25. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
ppo
deductible
claim
pcp
26. The period of time that payment for Medicare inpatient hospital benefits are available
state preemption
Covered Expenses
complience
benefit period
27. A list of the amount to be paid by an insurance company for each procedure service
etiquette
medical foundation
ee schedule
Covered Expenses
28. Verbal or written agreement that gives approval to some action - situation - or statement.
(PEC) Pre-existing condition
consent
referral
Security Rule
29. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
confidentiality
Specialist
consulting physician
Security Rule
30. 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.
nonprivileged information
Amblatory Care
Notice of Privacy Practices
(PPS) Hospital Impatient Prospective Payment System
31. An organization of provider sites with a contracted relationship that offer services
Beneficiary
ids
Claim
IIHI
32. 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
etiquette
Security Rule
Subscriber
clearinghouse
33. 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
Beneficiary
Assignment & Authorization
(EPO) Exclusive Provider Organization
medical foundation
34. Medical services provided on an outpatient basis
Amblatory Care
(DOS) Date of Service
security officer
subscriber
35. 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
(ABN) Advance Beneficiary Notice
phantom billing
ppo
Assignment & Authorization
36. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Treating or performing physician
Preauthorization
Consent form
37. Integrating benefits payable under more than one health insurance.
electronic media
security officer
IIHI
Coordinated Coverage
38. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
business associate
Referral
Medigap Insurance
complience plan
39. 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)
Out of Network (OON)
Supplementary Medical Insurance
Privileged information
Consent form
40. A rule - condition - or requirement
econdary Payer
Standard
(AOB) Assignment of Benefits
econdary Payer
41. A clinic that is owned by the HMO and the physicians are employees of the HMO
deductible
Security Rule
prepaid plan
closed panel HMO
42. American Medical Association
AMA
Coordinated Coverage
(COB) Coordination of Benefits
security officer
43. 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
(EPO) Exclusive Provider Organization
pcp
(ERISA) Employee Retirement Income Security Act of 1974
consent
44. 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
pcp
complience
security officer
45. Medical staff member who is legally responsible for the care and treatment given to a patient.
Individually identifiable health information
(TPA) Third Party Administrator
attending physician
ee schedule
46. 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
(Non-par) Non-Participating Provider
clearinghouse
pos
claim
47. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Out of Network (OON)
authorization form
claim
nonprivileged information
48. Billing for services not performed
phantom billing
Referral
(PPS) Hospital Impatient Prospective Payment System
econdary Payer
49. Health Information Portability and Accountability Act
(POS) Point-of Service Plan
health care provider
(DRG's)
HIPAA
50. Is the provider who renders a service to a patient
AMA
(UR) Utilization review
Treating or performing physician
clearinghouse