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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.
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. 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
Resonable Charge
econdary Payer
complience plan
Sub-acute Care
2. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
attending physician
consulting physician
Referral
3. 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.
nonprivileged information
security officer
closed panel HMO
medical foundation
4. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(PAC) Pre- Admission Certification
(PAC) Pre- Admission Certification
preauthorization
Sub-acute Care
5. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(UR) Utilization review
ordering physician
(PCN) Primary Care Network
transaction
6. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
transaction
e-health information management
Beneficiary
7. 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
consulting physician
Pre-existing Condition Exclusion
Assignment & Authorization
8. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
HIPAA
Claim
Standard
9. 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
Treating or performing physician
authorization form
closed panel HMO
10. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Consent form
Coordinated Coverage
(UR) Utilization review
11. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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12. A structure for classifying outpatient services and procedures for purpose of payment
(PEC) Pre-existing condition
Supplementary Medical Insurance
Protected health information
(APC) Ambulatory Patient Classifications
13. Customs - rules of conduct - courtesy - and manners of the medical profession
Treating or performing physician
etiquette
abuse
pcp
14. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured
HIPAA
premium
Deductible
(AOB) Assignment of Benefits
15. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
ethics
Open Enrollment
(EPO) Exclusive Provider Organization
ppo
16. Billing for services not performed
(PAC) Pre- Admission Certification
deductible
phantom billing
ids
17. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
HIPAA
(UR) Utilization review
Maximum Out Of Pocket
18. The dates of healthcare services were provided to the beneficiary
pos
Security Rule
attending physician
(DOS) Date of Service
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
health care provider
authorization form
Out of Network (OON)
Experimental Procedures
20. Integrating benefits payable under more than one health insurance.
pcp
Specialist
Coordinated Coverage
(PAC) Pre- Admission Certification
21. 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
Maximum Out Of Pocket
(PCP) Primary Care Physician
covered entity
abuse
22. 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
Embezzlement
cash flow
complience
23. Health Information Portability and Accountability Act
crossover claim
AMA
(DRG's)
HIPAA
24. Is a provider who sends the patients for testing or treatment
covered entity
nonprivileged information
Consent form
referring physician
25. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Specialist
complience plan
(PCN) Primary Care Network
Privileged information
26. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Standard
Treating or performing physician
HIPAA
abuse
27. 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.
ids
(EPO) Exclusive Provider Organization
Notice of Privacy Practices
clearinghouse
28. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Open Enrollment
Amblatory Care
Privileged information
complience
29. 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
phantom billing
ids
attending physician
30. Customs - rules of conduct - courtesy - and manners of the medical profession
hmo
authorization form
Confidential communication
etiquette
31. 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
Participating Provider
Out of Network (OON)
ordering physician
referral
32. A nonprofit integrated delivery system
privacy
privacy
medical foundation
Maximum Out Of Pocket
33. The dates of healthcare services were provided to the beneficiary
premium
(DOS) Date of Service
Standard
(DME) Durable Medical Equipment
34. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
benefit period
pos
consulting physician
Preauthorization
35. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Sub-acute Care
disclosure
Out of Network (OON)
open panel HMO
36. 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
Experimental Procedures
Confidential communication
HIPAA
Participating Provider
37. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Sub-acute Care
(PEC) Pre-existing condition
ordering physician
subscriber
38. 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.
Notice of Privacy Practices
subscriber
Specialist
Pre-existing Condition Exclusion
39. Someone who is eligible for or receiving benefits under an insurance policy or plan
pcp
Confidential communication
Consent form
Beneficiary
40. An intentional misrepresentation of the facts to deceive or mislead another.
Supplementary Medical Insurance
transaction
Network
fraud
41. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(DOS) Date of Service
electronic media
Open Enrollment
Network
42. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
AMA
e-health information management
(UR) Utilization review
complience
43. 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
(DME) Durable Medical Equipment
pcp
closed panel HMO
Specialist
44. 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.
(UR) Utilization review
(UCR) Usual - Customary and Reasonable
Protected health information
open panel HMO
45. A clinic that is owned by the HMO and the physicians are employees of the HMO
Claim
nonprivileged information
(PCN) Primary Care Network
closed panel HMO
46. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
clearinghouse
Allowed Expenses
Network
claim
47. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
nonprivileged information
(PCP) Primary Care Physician
econdary Payer
attending physician
48. A patient claim is eligible for medicare and medicaid
Assignment & Authorization
crossover claim
AMA
Specialist
49. 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
crossover claim
abuse
Sub-acute Care
Coordinated Coverage
50. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
Supplementary Medical Insurance
Standard
phantom billing