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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.
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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 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
benefit period
epo
(DME) Durable Medical Equipment
2. An intentional misrepresentation of the facts to deceive or mislead another.
benefit period
fraud
ids
attending physician
3. 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
(PPS) Hospital Impatient Prospective Payment System
Covered Expenses
Preauthorization
Security Rule
4. Integrating benefits payable under more than one health insurance.
subscriber
(APC) Ambulatory Patient Classifications
Coordinated Coverage
referring physician
5. 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
Standard
confidentiality
Supplementary Medical Insurance
(ABN) Advance Beneficiary Notice
6. 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.
Resonable Charge
Assignment & Authorization
ee schedule
business associate
7. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
Subscriber
attending physician
econdary Payer
8. Health Information Portability and Accountability Act
(PPS) Hospital Impatient Prospective Payment System
ee schedule
(COBRA)
HIPAA
9. 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
epo
(UCR) Usual - Customary and Reasonable
Supplementary Medical Insurance
(DOS) Date of Service
10. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
medical foundation
IIHI
premium
11. 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
covered entity
ordering physician
Out of Network (OON)
Subscriber
12. 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
attending physician
Deductible
ids
Medigap Insurance
13. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(ERISA) Employee Retirement Income Security Act of 1974
ee schedule
Subscriber
consulting physician
14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
phantom billing
Individually identifiable health information
consulting physician
ee schedule
15. 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.
self-referral
Privileged information
epo
(AOB) Assignment of Benefits
16. 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
consulting physician
attending physician
pos
Security Rule
17. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Subscriber
(APC) Ambulatory Patient Classifications
hmo
confidentiality
18. 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)
Sub-acute Care
Open Enrollment
(DRG's)
Consent form
19. A rule - condition - or requirement
ordering physician
Standard
(DOS) Date of Service
(PEC) Pre-existing condition
20. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Coordinated Coverage
preauthorization
breach of confidential communication
21. 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
ee schedule
Subscriber
privacy
(Non-par) Non-Participating Provider
22. 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.
(PAC) Pre- Admission Certification
transaction
health care provider
(DRG's)
23. A clinic that is owned by the HMO and the physicians are employees of the HMO
abuse
Resonable Charge
closed panel HMO
open panel HMO
24. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Medigap Insurance
Network
Resonable Charge
25. 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
crossover claim
deductible
Pre-existing Condition Exclusion
IIHI
26. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Network
transaction
Resonable Charge
fraud
27. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
authorization form
Participating Provider
Protected health information
(POS) Point-of Service Plan
28. 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
complience
Deductible
Individually identifiable health information
crossover claim
29. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
Open Enrollment
(POS) Point-of Service Plan
Privileged information
Privacy officer
30. A health insurance enrollee chooses to see an out of network provider without authorization
subscriber
self-referral
ethics
electronic media
31. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
transaction
business associate
ordering physician
(UCR) Usual - Customary and Reasonable
32. 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
(PCP) Primary Care Physician
Security Rule
medical foundation
business associate
33. The amount of actual money available to the medical practice
cash flow
Privacy officer
Security Rule
benefit period
34. 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
complience plan
preauthorization
Supplementary Medical Insurance
subscriber
35. 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.
Privileged information
(Non-par) Non-Participating Provider
phantom billing
ethics
36. A provision that apples when a person is covered under more than one group medical program
Privacy officer
(COB) Coordination of Benefits
HIPAA
(UCR) Usual - Customary and Reasonable
37. 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
breach of confidential communication
crossover claim
hmo
38. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Assignment & Authorization
disclosure
Sub-acute Care
(PAC) Pre- Admission Certification
39. A list of the amount to be paid by an insurance company for each procedure service
business associate
Standard
IIHI
ee schedule
40. 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
Protected health information
Medigap Insurance
Preauthorization
Specialist
41. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
Privacy officer
Deductible
Pre-existing Condition Exclusion
consent
42. Medicare's method of paying acute care hospitals for inpatient care
(DOS) Date of Service
Confidential communication
(PPS) Hospital Impatient Prospective Payment System
hmo
43. Approval or consent by a primary physician for patient referral to ancillary services and specialists
complience plan
(AOB) Assignment of Benefits
(DRG's)
Referral
44. 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.
Network
(DME) Durable Medical Equipment
(PAC) Pre- Admission Certification
state preemption
45. The transmission of information between two parties to carry out financial or administrative activities related to health care.
consent
abuse
transaction
medical foundation
46. A patient claim is eligible for medicare and medicaid
crossover claim
fraud
Confidential communication
Security Rule
47. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(UR) Utilization review
(OOPs) Out of Pocket Costs/Expenses
Security Rule
Subscriber
48. Is the provider who renders a service to a patient
Pre-certification
Treating or performing physician
referral
econdary Payer
49. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(UR) Utilization review
Resonable Charge
Network
(PAC) Pre- Admission Certification
50. Health Information Portability and Accountability Act
HIPAA
complience
Allowed Expenses
(ABN) Advance Beneficiary Notice