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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 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
(PEC) Pre-existing condition
attending physician
(EPO) Exclusive Provider Organization
2. Medicare's method of paying acute care hospitals for inpatient care
(PAC) Pre- Admission Certification
(PPS) Hospital Impatient Prospective Payment System
(POS) Point-of Service Plan
(COBRA)
3. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Privacy officer
self-referral
Specialist
Standard
4. 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
Sub-acute Care
(UCR) Usual - Customary and Reasonable
health care provider
econdary Payer
5. Health Information Portability and Accountability Act
Beneficiary
Privileged information
HIPAA
business associate
6. 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
claim
benefit period
nonprivileged information
Participating Provider
7. 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
Network
Privileged information
Out of Network (OON)
(POS) Point-of Service Plan
8. A health insurance enrollee chooses to see an out of network provider without authorization
Pre-existing Condition Exclusion
IIHI
(ABN) Advance Beneficiary Notice
self-referral
9. 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
Consent form
referral
authorization form
10. 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
hmo
(DME) Durable Medical Equipment
(PCN) Primary Care Network
(UCR) Usual - Customary and Reasonable
11. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
abuse
(Non-par) Non-Participating Provider
Assignment & Authorization
12. The maximum amount a plan pays for a covered service
Allowed Expenses
Maximum Out Of Pocket
Maximum Out Of Pocket
premium
13. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(PEC) Pre-existing condition
Individually identifiable health information
security officer
(POS) Point-of Service Plan
14. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(DRG's)
crossover claim
deductible
abuse
15. Medical staff member who is legally responsible for the care and treatment given to a patient.
open panel HMO
etiquette
attending physician
(APC) Ambulatory Patient Classifications
16. 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
clearinghouse
Beneficiary
Out of Network (OON)
disclosure
17. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
ppo
medical foundation
(COBRA)
Treating or performing physician
18. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Participating Provider
hmo
health care provider
claim
19. 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
Beneficiary
Supplementary Medical Insurance
(TPA) Third Party Administrator
medical foundation
20. The maximum amount a plan pays for a covered service
referring physician
Allowed Expenses
Privileged information
IIHI
21. 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.
Maximum Out Of Pocket
Notice of Privacy Practices
self-referral
(TPA) Third Party Administrator
22. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
crossover claim
transaction
Protected health information
complience plan
23. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
(UCR) Usual - Customary and Reasonable
Specialist
Embezzlement
Protected health information
24. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
pos
phantom billing
Claim
consent
25. Medical staff member who is legally responsible for the care and treatment given to a patient.
HIPAA
(ERISA) Employee Retirement Income Security Act of 1974
(DOS) Date of Service
attending physician
26. 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
(UR) Utilization review
HIPAA
Pre-existing Condition Exclusion
Preauthorization
27. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
medical foundation
Referral
deductible
clearinghouse
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
crossover claim
e-health information management
Deductible
Amblatory Care
29. 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
Supplementary Medical Insurance
Maximum Out Of Pocket
Covered Expenses
30. A rule - condition - or requirement
disclosure
Specialist
Standard
Coordinated Coverage
31. 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
Maximum Out Of Pocket
(UCR) Usual - Customary and Reasonable
(UR) Utilization review
32. 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
(DME) Durable Medical Equipment
Supplementary Medical Insurance
Resonable Charge
Pre-existing Condition Exclusion
33. 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
econdary Payer
ppo
Assignment & Authorization
(DOS) Date of Service
34. An intentional misrepresentation of the facts to deceive or mislead another.
(TPA) Third Party Administrator
benefit period
fraud
(DME) Durable Medical Equipment
35. 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.
(AOB) Assignment of Benefits
(DOS) Date of Service
(UR) Utilization review
business associate
36. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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37. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Subscriber
consent
e-health information management
Resonable Charge
38. A patient claim is eligible for medicare and medicaid
(PAC) Pre- Admission Certification
Experimental Procedures
crossover claim
security officer
39. The condition of being secluded from the presence or view of others.
(DME) Durable Medical Equipment
privacy
etiquette
Amblatory Care
40. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
econdary Payer
abuse
ee schedule
41. American Medical Association
referring physician
(AOB) Assignment of Benefits
(DCI) Duplicate Coverage Inquiry
AMA
42. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(DME) Durable Medical Equipment
consulting physician
Medigap Insurance
(DOS) Date of Service
43. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
Resonable Charge
Experimental Procedures
(COBRA)
Maximum Out Of Pocket
44. Standards of conduct generally accepted as a moral guide for behavior.
Pre-existing Condition Exclusion
(PCP) Primary Care Physician
complience
ethics
45. 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
health care provider
Claim
crossover claim
46. Health Information Portability and Accountability Act
Pre-existing Condition Exclusion
HIPAA
cash flow
health care provider
47. The dates of healthcare services were provided to the beneficiary
referral
Amblatory Care
Referral
(DOS) Date of Service
48. A willful act by an employee of taking possession of an employer's money
Participating Provider
business associate
Embezzlement
Referral
49. 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
(Non-par) Non-Participating Provider
security officer
pos
health care provider
50. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
IIHI
complience plan
ee schedule
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