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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 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
medical foundation
Beneficiary
Preauthorization
Deductible
2. 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
(DCI) Duplicate Coverage Inquiry
Pre-existing Condition Exclusion
Out of Network (OON)
(UR) Utilization review
3. 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
(OOPs) Out of Pocket Costs/Expenses
Maximum Out Of Pocket
(APC) Ambulatory Patient Classifications
Preauthorization
4. 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
ppo
Pre-certification
nonprivileged information
Assignment & Authorization
5. Integrating benefits payable under more than one health insurance.
Allowed Expenses
pos
Coordinated Coverage
abuse
6. 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
pcp
(UCR) Usual - Customary and Reasonable
Maximum Out Of Pocket
7. 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.
etiquette
(COB) Coordination of Benefits
health care provider
Referral
8. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Referral
(DRG's)
attending physician
consulting physician
9. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(ABN) Advance Beneficiary Notice
hmo
(DME) Durable Medical Equipment
transaction
10. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
Pre-certification
(OOPs) Out of Pocket Costs/Expenses
(EPO) Exclusive Provider Organization
11. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
health care provider
confidentiality
cash flow
12. 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
Experimental Procedures
crossover claim
Privileged information
13. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(UCR) Usual - Customary and Reasonable
self-referral
disclosure
(AOB) Assignment of Benefits
14. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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15. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
Open Enrollment
covered entity
open panel HMO
closed panel HMO
16. 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
business associate
Claim
ids
17. 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
Notice of Privacy Practices
(DME) Durable Medical Equipment
privacy
Coordinated Coverage
18. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
IIHI
epo
Resonable Charge
19. 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
Open Enrollment
prepaid plan
20. A willful act by an employee of taking possession of an employer's money
(PEC) Pre-existing condition
(DME) Durable Medical Equipment
ordering physician
Embezzlement
21. American Medical Association
phantom billing
Sub-acute Care
AMA
health care provider
22. 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
Security Rule
fraud
Assignment & Authorization
23. 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
Medigap Insurance
Coordinated Coverage
state preemption
(ERISA) Employee Retirement Income Security Act of 1974
24. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(POS) Point-of Service Plan
deductible
claim
(TPA) Third Party Administrator
25. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Protected health information
Security Rule
hmo
pcp
26. 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
(DME) Durable Medical Equipment
complience
Medigap Insurance
(PCP) Primary Care Physician
27. 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
deductible
covered entity
ordering physician
(Non-par) Non-Participating Provider
28. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
ppo
authorization form
clearinghouse
Participating Provider
29. 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
self-referral
(EPO) Exclusive Provider Organization
authorization form
(DME) Durable Medical Equipment
30. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
Embezzlement
Privacy officer
ppo
31. 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
Privileged information
Out of Network (OON)
(PCN) Primary Care Network
complience plan
32. 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
(COB) Coordination of Benefits
(COB) Coordination of Benefits
Maximum Out Of Pocket
cash flow
33. A rule - condition - or requirement
Standard
Treating or performing physician
self-referral
Referral
34. A health insurance enrollee chooses to see an out of network provider without authorization
(DOS) Date of Service
self-referral
preauthorization
AMA
35. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Maximum Out Of Pocket
health care provider
(EPO) Exclusive Provider Organization
state preemption
36. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
electronic media
(DCI) Duplicate Coverage Inquiry
(UR) Utilization review
hmo
37. A monthly fee paid by the insured for specific medical insurance coverage
ordering physician
AMA
premium
consulting physician
38. 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
Sub-acute Care
pos
claim
39. 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
Covered Expenses
disclosure
(ABN) Advance Beneficiary Notice
nonprivileged information
40. The maximum amount a plan pays for a covered service
confidentiality
Allowed Expenses
referral
AMA
41. 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
Medigap Insurance
Participating Provider
(APC) Ambulatory Patient Classifications
consent
42. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
open panel HMO
Participating Provider
covered entity
43. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
medical foundation
(AOB) Assignment of Benefits
(TPA) Third Party Administrator
prepaid plan
44. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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45. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
phantom billing
covered entity
econdary Payer
(UCR) Usual - Customary and Reasonable
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
medical foundation
pos
(PEC) Pre-existing condition
authorization form
47. The dates of healthcare services were provided to the beneficiary
hmo
Medigap Insurance
(DOS) Date of Service
health care provider
48. The period of time that payment for Medicare inpatient hospital benefits are available
pcp
benefit period
(PEC) Pre-existing condition
e-health information management
49. 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)
disclosure
Consent form
Referral
state preemption
50. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
e-health information management
pcp
benefit period
IIHI