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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 term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
(DOS) Date of Service
econdary Payer
Beneficiary
2. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(DME) Durable Medical Equipment
transaction
Confidential communication
e-health information management
3. American Medical Association
prepaid plan
referral
Experimental Procedures
AMA
4. A clinic that is owned by the HMO and the physicians are employees of the HMO
open panel HMO
security officer
closed panel HMO
hmo
5. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
Privacy officer
Individually identifiable health information
(DCI) Duplicate Coverage Inquiry
6. Medical services provided on an outpatient basis
Notice of Privacy Practices
Claim
ppo
Amblatory Care
7. What the insurance company will consider paying for as defined in the contract.
(DRG's)
Covered Expenses
e-health information management
hmo
8. 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
pos
preauthorization
referral
9. 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.
(Non-par) Non-Participating Provider
cash flow
health care provider
Privileged information
10. An organization of provider sites with a contracted relationship that offer services
ids
Supplementary Medical Insurance
health care provider
deductible
11. 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
ee schedule
Pre-existing Condition Exclusion
Sub-acute Care
Experimental Procedures
12. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Individually identifiable health information
Claim
(TPA) Third Party Administrator
Resonable Charge
13. A review of the need for inpatient hospital care - completed before the actual admission
IIHI
(PAC) Pre- Admission Certification
complience
Confidential communication
14. The period of time that payment for Medicare inpatient hospital benefits are available
AMA
Sub-acute Care
Protected health information
benefit period
15. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Specialist
premium
abuse
16. 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
Security Rule
Notice of Privacy Practices
Experimental Procedures
benefit period
17. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
referral
fraud
Consent form
18. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Coordinated Coverage
subscriber
Treating or performing physician
19. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
econdary Payer
Security Rule
(COB) Coordination of Benefits
complience
20. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
(PEC) Pre-existing condition
ethics
Referral
21. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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22. 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
pcp
Out of Network (OON)
Confidential communication
23. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
fraud
Pre-certification
business associate
24. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
(COBRA)
disclosure
breach of confidential communication
25. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
benefit period
AMA
deductible
26. A nonprofit integrated delivery system
(PAC) Pre- Admission Certification
complience
medical foundation
(PCN) Primary Care Network
27. 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
Assignment & Authorization
covered entity
open panel HMO
Experimental Procedures
28. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
attending physician
(PCN) Primary Care Network
abuse
29. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(PPS) Hospital Impatient Prospective Payment System
(DCI) Duplicate Coverage Inquiry
pcp
(DRG's)
30. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
hmo
deductible
(DCI) Duplicate Coverage Inquiry
31. 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
(POS) Point-of Service Plan
(PAC) Pre- Admission Certification
breach of confidential communication
Consent form
32. 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.
Amblatory Care
(COB) Coordination of Benefits
Assignment & Authorization
Notice of Privacy Practices
33. 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
Privacy officer
Embezzlement
(ABN) Advance Beneficiary Notice
(AOB) Assignment of Benefits
34. A willful act by an employee of taking possession of an employer's money
Referral
Embezzlement
consulting physician
(DOS) Date of Service
35. The condition of being secluded from the presence or view of others.
privacy
Pre-certification
Protected health information
state preemption
36. 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.
business associate
etiquette
confidentiality
Out of Network (OON)
37. 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.
claim
security officer
ids
(ERISA) Employee Retirement Income Security Act of 1974
38. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
ee schedule
Participating Provider
(EPO) Exclusive Provider Organization
Privileged information
39. What the insurance company will consider paying for as defined in the contract.
crossover claim
Covered Expenses
Specialist
referring physician
40. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
preauthorization
Claim
Supplementary Medical Insurance
Network
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.
authorization form
Sub-acute Care
Specialist
Privacy officer
42. 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.
IIHI
Participating Provider
Notice of Privacy Practices
Protected health information
43. The condition of being secluded from the presence or view of others.
(DME) Durable Medical Equipment
privacy
claim
(DME) Durable Medical Equipment
44. 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
security officer
Covered Expenses
crossover claim
ppo
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
(ABN) Advance Beneficiary Notice
electronic media
(Non-par) Non-Participating Provider
e-health information management
46. A health insurance enrollee chooses to see an out of network provider without authorization
open panel HMO
self-referral
(PCN) Primary Care Network
(ERISA) Employee Retirement Income Security Act of 1974
47. 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
Coordinated Coverage
authorization form
covered entity
Covered Expenses
48. A health insurance enrollee chooses to see an out of network provider without authorization
HIPAA
privacy
Notice of Privacy Practices
self-referral
49. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
attending physician
(PAC) Pre- Admission Certification
preauthorization
Supplementary Medical Insurance
50. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
Participating Provider
Referral
(TPA) Third Party Administrator
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