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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. 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
fraud
authorization form
(COB) Coordination of Benefits
(PCP) Primary Care Physician
2. A rule - condition - or requirement
deductible
Standard
ee schedule
cash flow
3. 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
ethics
health care provider
(DCI) Duplicate Coverage Inquiry
4. 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
(APC) Ambulatory Patient Classifications
(COBRA)
privacy
(OOPs) Out of Pocket Costs/Expenses
5. A monthly fee paid by the insured for specific medical insurance coverage
Subscriber
premium
disclosure
Open Enrollment
6. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
etiquette
Participating Provider
Notice of Privacy Practices
complience
7. 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
(PCN) Primary Care Network
Privileged information
Claim
IIHI
8. A clinic that is owned by the HMO and the physicians are employees of the HMO
crossover claim
(DCI) Duplicate Coverage Inquiry
Privacy officer
closed panel HMO
9. 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
cash flow
preauthorization
(COBRA)
consulting physician
10. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Privileged information
phantom billing
state preemption
11. Unauthorized release of information
etiquette
breach of confidential communication
subscriber
Allowed Expenses
12. 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
Covered Expenses
(POS) Point-of Service Plan
Pre-existing Condition Exclusion
abuse
13. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Notice of Privacy Practices
(POS) Point-of Service Plan
ordering physician
hmo
14. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
breach of confidential communication
pos
clearinghouse
(PCN) Primary Care Network
15. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
preauthorization
Consent form
subscriber
claim
16. 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
Supplementary Medical Insurance
closed panel HMO
(PAC) Pre- Admission Certification
clearinghouse
17. 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
(COB) Coordination of Benefits
confidentiality
Standard
Security Rule
18. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
econdary Payer
IIHI
epo
19. 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
cash flow
closed panel HMO
Maximum Out Of Pocket
(AOB) Assignment of Benefits
20. A review of the need for inpatient hospital care - completed before the actual admission
crossover claim
benefit period
Open Enrollment
(PAC) Pre- Admission Certification
21. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
ordering physician
confidentiality
epo
Referral
22. 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
authorization form
Confidential communication
abuse
Participating Provider
23. 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.
medical foundation
abuse
Notice of Privacy Practices
(DME) Durable Medical Equipment
24. 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
(EPO) Exclusive Provider Organization
(ABN) Advance Beneficiary Notice
hmo
25. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
attending physician
econdary Payer
(PPS) Hospital Impatient Prospective Payment System
confidentiality
26. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Privacy officer
econdary Payer
ppo
27. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
medical foundation
Privacy officer
Specialist
Subscriber
28. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
deductible
state preemption
hmo
Individually identifiable health information
29. 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.
(ERISA) Employee Retirement Income Security Act of 1974
(Non-par) Non-Participating Provider
security officer
closed panel HMO
30. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
state preemption
nonprivileged information
(ERISA) Employee Retirement Income Security Act of 1974
disclosure
31. Medical services provided on an outpatient basis
ethics
(ERISA) Employee Retirement Income Security Act of 1974
Amblatory Care
security officer
32. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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33. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
clearinghouse
(PAC) Pre- Admission Certification
nonprivileged information
34. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Participating Provider
Medigap Insurance
clearinghouse
Security Rule
35. Standards of conduct generally accepted as a moral guide for behavior.
Out of Network (OON)
ethics
Maximum Out Of Pocket
Open Enrollment
36. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Maximum Out Of Pocket
Medigap Insurance
disclosure
37. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
crossover claim
(PPS) Hospital Impatient Prospective Payment System
transaction
(EPO) Exclusive Provider Organization
38. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
(OOPs) Out of Pocket Costs/Expenses
Network
(OOPs) Out of Pocket Costs/Expenses
Maximum Out Of Pocket
39. 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.
(ABN) Advance Beneficiary Notice
Security Rule
Privileged information
(PEC) Pre-existing condition
40. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
phantom billing
breach of confidential communication
Maximum Out Of Pocket
consulting physician
41. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Beneficiary
security officer
Specialist
e-health information management
42. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
referral
(PCP) Primary Care Physician
electronic media
(ABN) Advance Beneficiary Notice
43. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(DOS) Date of Service
ee schedule
consulting physician
hmo
44. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
electronic media
(COBRA)
(OOPs) Out of Pocket Costs/Expenses
covered entity
45. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(OOPs) Out of Pocket Costs/Expenses
(UR) Utilization review
ordering physician
Referral
46. The maximum amount a plan pays for a covered service
e-health information management
Allowed Expenses
complience plan
confidentiality
47. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
epo
HIPAA
Resonable Charge
referring physician
48. 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
Security Rule
Pre-existing Condition Exclusion
(PAC) Pre- Admission Certification
e-health information management
49. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
(AOB) Assignment of Benefits
(APC) Ambulatory Patient Classifications
ee schedule
50. Is a provider who sends the patients for testing or treatment
referring physician
preauthorization
Subscriber
(EPO) Exclusive Provider Organization
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