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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
Supplementary Medical Insurance
Experimental Procedures
ids
(ABN) Advance Beneficiary Notice
2. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
nonprivileged information
prepaid plan
deductible
hmo
3. A rule - condition - or requirement
Consent form
Preauthorization
Standard
Protected health information
4. The maximum amount a plan pays for a covered service
cash flow
Allowed Expenses
referral
Claim
5. An organization of provider sites with a contracted relationship that offer services
econdary Payer
(DCI) Duplicate Coverage Inquiry
ids
attending physician
6. Verbal or written agreement that gives approval to some action - situation - or statement.
covered entity
(ABN) Advance Beneficiary Notice
consent
Resonable Charge
7. Medical services provided on an outpatient basis
Amblatory Care
(UR) Utilization review
(DME) Durable Medical Equipment
covered entity
8. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Referral
health care provider
Allowed Expenses
9. A willful act by an employee of taking possession of an employer's money
Out of Network (OON)
prepaid plan
fraud
Embezzlement
10. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Experimental Procedures
transaction
Notice of Privacy Practices
Referral
11. Health Information Portability and Accountability Act
attending physician
preauthorization
(OOPs) Out of Pocket Costs/Expenses
HIPAA
12. The condition of being secluded from the presence or view of others.
AMA
epo
privacy
Resonable Charge
13. A nonprofit integrated delivery system
open panel HMO
closed panel HMO
medical foundation
ppo
14. 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
Embezzlement
benefit period
Participating Provider
econdary Payer
15. 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
econdary Payer
medical foundation
clearinghouse
pos
16. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
(ABN) Advance Beneficiary Notice
(POS) Point-of Service Plan
(PEC) Pre-existing condition
17. 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
medical foundation
Protected health information
Sub-acute Care
(AOB) Assignment of Benefits
18. 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
crossover claim
IIHI
confidentiality
19. An intentional misrepresentation of the facts to deceive or mislead another.
(POS) Point-of Service Plan
fraud
(COBRA)
Confidential communication
20. 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
consulting physician
state preemption
referral
21. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
nonprivileged information
cash flow
Specialist
(APC) Ambulatory Patient Classifications
22. 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.
Open Enrollment
attending physician
Privileged information
(TPA) Third Party Administrator
23. 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
privacy
state preemption
Maximum Out Of Pocket
Referral
24. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(UCR) Usual - Customary and Reasonable
(Non-par) Non-Participating Provider
Resonable Charge
Maximum Out Of Pocket
25. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
IIHI
Medigap Insurance
disclosure
Amblatory Care
26. Is the provider who renders a service to a patient
Treating or performing physician
(PEC) Pre-existing condition
Preauthorization
closed panel HMO
27. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Protected health information
open panel HMO
pos
Resonable Charge
28. Standards of conduct generally accepted as a moral guide for behavior.
Sub-acute Care
disclosure
ethics
closed panel HMO
29. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
ordering physician
phantom billing
(TPA) Third Party Administrator
Network
30. 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
Individually identifiable health information
Security Rule
(DME) Durable Medical Equipment
referring physician
31. 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
Amblatory Care
health care provider
Claim
Pre-existing Condition Exclusion
32. 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
Sub-acute Care
privacy
(DOS) Date of Service
Medigap Insurance
33. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
referral
claim
Deductible
34. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Notice of Privacy Practices
Claim
pos
referral
35. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Out of Network (OON)
phantom billing
abuse
deductible
36. 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.
disclosure
health care provider
Claim
AMA
37. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Privacy officer
(PEC) Pre-existing condition
phantom billing
Security Rule
38. The maximum amount a plan pays for a covered service
Standard
disclosure
nonprivileged information
Allowed Expenses
39. 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
medical foundation
HIPAA
(AOB) Assignment of Benefits
Network
40. 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
ordering physician
(COB) Coordination of Benefits
consent
Open Enrollment
41. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Coordinated Coverage
confidentiality
benefit period
self-referral
42. 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
(PCN) Primary Care Network
Embezzlement
benefit period
privacy
43. Medicare's method of paying acute care hospitals for inpatient care
hmo
(PPS) Hospital Impatient Prospective Payment System
ordering physician
cash flow
44. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
cash flow
AMA
privacy
deductible
45. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(PCP) Primary Care Physician
Standard
confidentiality
Network
46. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Subscriber
pos
subscriber
e-health information management
47. 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
(PEC) Pre-existing condition
ppo
hmo
(ERISA) Employee Retirement Income Security Act of 1974
48. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
HIPAA
medical foundation
business associate
subscriber
49. 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
electronic media
referring physician
(PCN) Primary Care Network
consent
50. 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.
health care provider
disclosure
abuse
Experimental Procedures