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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. 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
Pre-existing Condition Exclusion
ppo
referral
crossover claim
2. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
pos
covered entity
Covered Expenses
3. Is the provider who renders a service to a patient
(UCR) Usual - Customary and Reasonable
Treating or performing physician
Pre-existing Condition Exclusion
security officer
4. A structure for classifying outpatient services and procedures for purpose of payment
Privacy officer
Beneficiary
(APC) Ambulatory Patient Classifications
preauthorization
5. A provision that apples when a person is covered under more than one group medical program
Embezzlement
deductible
(COB) Coordination of Benefits
pcp
6. American Medical Association
privacy
complience
(UR) Utilization review
AMA
7. A willful act by an employee of taking possession of an employer's money
consent
Embezzlement
(COBRA)
Participating Provider
8. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
premium
e-health information management
deductible
9. The period of time that payment for Medicare inpatient hospital benefits are available
health care provider
consent
Amblatory Care
benefit period
10. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
self-referral
Resonable Charge
(PPS) Hospital Impatient Prospective Payment System
(DME) Durable Medical Equipment
11. Billing for services not performed
(PCN) Primary Care Network
phantom billing
prepaid plan
Standard
12. Standards of conduct generally accepted as a moral guide for behavior.
(UR) Utilization review
ethics
complience
(PCN) Primary Care Network
13. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
subscriber
open panel HMO
subscriber
(DCI) Duplicate Coverage Inquiry
14. 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.
business associate
state preemption
Pre-certification
Pre-existing Condition Exclusion
15. The amount of actual money available to the medical practice
(EPO) Exclusive Provider Organization
IIHI
epo
cash flow
16. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(OOPs) Out of Pocket Costs/Expenses
(ERISA) Employee Retirement Income Security Act of 1974
confidentiality
(AOB) Assignment of Benefits
17. 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
abuse
Allowed Expenses
(ABN) Advance Beneficiary Notice
(DME) Durable Medical Equipment
18. A review of the need for inpatient hospital care - completed before the actual admission
ethics
(PAC) Pre- Admission Certification
authorization form
(COBRA)
19. 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
transaction
Individually identifiable health information
Coordinated Coverage
20. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method
pos
epo
(ERISA) Employee Retirement Income Security Act of 1974
Privacy officer
21. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
privacy
ee schedule
Preauthorization
22. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Supplementary Medical Insurance
Maximum Out Of Pocket
disclosure
Experimental Procedures
23. 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
confidentiality
prepaid plan
open panel HMO
ordering physician
24. A clinic that is owned by the HMO and the physicians are employees of the HMO
Medigap Insurance
Treating or performing physician
closed panel HMO
Pre-existing Condition Exclusion
25. A privileged communication that may be disclosed only with the patient's permission.
ee schedule
Confidential communication
premium
Coordinated Coverage
26. A nonprofit integrated delivery system
(OOPs) Out of Pocket Costs/Expenses
AMA
medical foundation
confidentiality
27. 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
Assignment & Authorization
Supplementary Medical Insurance
(PCN) Primary Care Network
Standard
28. The period of time that payment for Medicare inpatient hospital benefits are available
pos
security officer
cash flow
benefit period
29. 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.
prepaid plan
Privileged information
Coordinated Coverage
business associate
30. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
epo
pcp
Pre-certification
Notice of Privacy Practices
31. Verbal or written agreement that gives approval to some action - situation - or statement.
(OOPs) Out of Pocket Costs/Expenses
consent
(COBRA)
ethics
32. 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
ethics
nonprivileged information
Sub-acute Care
33. 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
premium
referral
(DME) Durable Medical Equipment
premium
34. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
preauthorization
HIPAA
ee schedule
35. Medical staff member who is legally responsible for the care and treatment given to a patient.
(PPS) Hospital Impatient Prospective Payment System
Embezzlement
attending physician
benefit period
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.
Notice of Privacy Practices
confidentiality
health care provider
(PAC) Pre- Admission Certification
37. The dates of healthcare services were provided to the beneficiary
Privacy officer
attending physician
(DOS) Date of Service
complience
38. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
state preemption
(TPA) Third Party Administrator
pos
consulting physician
39. American Medical Association
claim
AMA
(POS) Point-of Service Plan
consent
40. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(ABN) Advance Beneficiary Notice
claim
breach of confidential communication
covered entity
41. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Deductible
Consent form
epo
Allowed Expenses
42. 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
(COB) Coordination of Benefits
Individually identifiable health information
(DCI) Duplicate Coverage Inquiry
prepaid plan
43. An organization of provider sites with a contracted relationship that offer services
(OOPs) Out of Pocket Costs/Expenses
Coordinated Coverage
ids
premium
44. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Out of Network (OON)
abuse
(UR) Utilization review
Notice of Privacy Practices
45. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
subscriber
ids
clearinghouse
Covered Expenses
46. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Amblatory Care
Covered Expenses
Deductible
47. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
ids
prepaid plan
Experimental Procedures
abuse
48. 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
closed panel HMO
nonprivileged information
(ABN) Advance Beneficiary Notice
Security Rule
49. A monthly fee paid by the insured for specific medical insurance coverage
econdary Payer
premium
referring physician
ppo
50. 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
(POS) Point-of Service Plan
(DRG's)
Embezzlement