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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
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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. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Pre-certification
Allowed Expenses
Protected health information
2. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
medical foundation
preauthorization
Consent form
(TPA) Third Party Administrator
3. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Pre-existing Condition Exclusion
etiquette
Referral
(EPO) Exclusive Provider Organization
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
Protected health information
(COB) Coordination of Benefits
Out of Network (OON)
(ERISA) Employee Retirement Income Security Act of 1974
5. 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
Participating Provider
Preauthorization
(PCP) Primary Care Physician
6. A nonprofit integrated delivery system
Consent form
transaction
medical foundation
Out of Network (OON)
7. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Pre-existing Condition Exclusion
(OOPs) Out of Pocket Costs/Expenses
closed panel HMO
(PCP) Primary Care Physician
8. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Beneficiary
(COB) Coordination of Benefits
Resonable Charge
ordering physician
9. A rule - condition - or requirement
cash flow
Standard
(ERISA) Employee Retirement Income Security Act of 1974
(AOB) Assignment of Benefits
10. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
crossover claim
(AOB) Assignment of Benefits
clearinghouse
(UR) Utilization review
11. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(TPA) Third Party Administrator
Security Rule
(DCI) Duplicate Coverage Inquiry
Sub-acute Care
12. 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
cash flow
(PAC) Pre- Admission Certification
pos
13. The amount of actual money available to the medical practice
cash flow
(COB) Coordination of Benefits
Supplementary Medical Insurance
Embezzlement
14. 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
deductible
covered entity
Covered Expenses
IIHI
15. Someone who is eligible for or receiving benefits under an insurance policy or plan
Covered Expenses
AMA
Beneficiary
privacy
16. Medicare's method of paying acute care hospitals for inpatient care
nonprivileged information
(PPS) Hospital Impatient Prospective Payment System
Deductible
(AOB) Assignment of Benefits
17. Medical staff member who is legally responsible for the care and treatment given to a patient.
Privacy officer
attending physician
Embezzlement
Individually identifiable health information
18. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
medical foundation
Specialist
electronic media
open panel HMO
19. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
breach of confidential communication
medical foundation
hmo
20. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Privileged information
clearinghouse
ee schedule
hmo
21. 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
referral
security officer
Maximum Out Of Pocket
Participating Provider
22. 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
ppo
Open Enrollment
state preemption
consent
23. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Claim
Pre-certification
Experimental Procedures
authorization form
24. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
25. 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
Treating or performing physician
HIPAA
Subscriber
Maximum Out Of Pocket
26. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
Confidential communication
Experimental Procedures
privacy
etiquette
27. 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
Experimental Procedures
ordering physician
prepaid plan
28. A provision that apples when a person is covered under more than one group medical program
Sub-acute Care
(COB) Coordination of Benefits
Assignment & Authorization
(PEC) Pre-existing condition
29. American Medical Association
authorization form
(PCP) Primary Care Physician
AMA
Participating Provider
30. 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
Amblatory Care
Beneficiary
phantom billing
Sub-acute Care
31. 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.
attending physician
Notice of Privacy Practices
(DOS) Date of Service
crossover claim
32. 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
Referral
(DOS) Date of Service
Coordinated Coverage
prepaid plan
33. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
(EPO) Exclusive Provider Organization
Notice of Privacy Practices
fraud
34. Verbal or written agreement that gives approval to some action - situation - or statement.
Privileged information
consent
referring physician
Claim
35. The period of time that payment for Medicare inpatient hospital benefits are available
clearinghouse
(DOS) Date of Service
cash flow
benefit period
36. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(PEC) Pre-existing condition
e-health information management
Pre-existing Condition Exclusion
Covered Expenses
37. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Beneficiary
Open Enrollment
ordering physician
health care provider
38. Health Information Portability and Accountability Act
complience plan
HIPAA
complience
self-referral
39. 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.
health care provider
Privileged information
Allowed Expenses
(COB) Coordination of Benefits
40. 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
Consent form
Preauthorization
ppo
(PCN) Primary Care Network
41. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
ee schedule
Pre-certification
e-health information management
transaction
42. 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
referral
(PCP) Primary Care Physician
transaction
Specialist
43. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
ethics
etiquette
Embezzlement
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
Preauthorization
Protected health information
(COB) Coordination of Benefits
(UCR) Usual - Customary and Reasonable
45. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
46. 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
ethics
electronic media
(ABN) Advance Beneficiary Notice
econdary Payer
47. 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
consent
deductible
(PEC) Pre-existing condition
48. 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
cash flow
open panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
Out of Network (OON)
49. A privileged communication that may be disclosed only with the patient's permission.
fraud
Resonable Charge
Confidential communication
Claim
50. 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.
crossover claim
state preemption
(APC) Ambulatory Patient Classifications
medical foundation