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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
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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 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
Deductible
Coordinated Coverage
consulting physician
(PEC) Pre-existing condition
2. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(DOS) Date of Service
Pre-certification
complience plan
hmo
3. 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
confidentiality
Pre-certification
business associate
pos
4. Is the provider who renders a service to a patient
benefit period
Treating or performing physician
Claim
breach of confidential communication
5. 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.
ppo
Sub-acute Care
Privacy officer
fraud
6. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor
Assignment & Authorization
Beneficiary
nonprivileged information
attending physician
7. Customs - rules of conduct - courtesy - and manners of the medical profession
Resonable Charge
etiquette
self-referral
attending physician
8. Billing for services not performed
premium
clearinghouse
Protected health information
phantom billing
9. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
complience
e-health information management
health care provider
10. A health insurance enrollee chooses to see an out of network provider without authorization
prepaid plan
self-referral
Coordinated Coverage
complience plan
11. 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
(OOPs) Out of Pocket Costs/Expenses
Referral
Beneficiary
12. 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
self-referral
medical foundation
fraud
13. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
benefit period
Covered Expenses
covered entity
Specialist
14. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
state preemption
Specialist
etiquette
15. 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
ppo
HIPAA
prepaid plan
Out of Network (OON)
16. A patient claim is eligible for medicare and medicaid
(PCN) Primary Care Network
crossover claim
Resonable Charge
Confidential communication
17. 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
Deductible
Pre-existing Condition Exclusion
Subscriber
Privileged information
18. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
deductible
prepaid plan
complience
Pre-existing Condition Exclusion
19. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Sub-acute Care
ethics
complience
20. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Treating or performing physician
complience
Participating Provider
transaction
21. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
open panel HMO
Embezzlement
referral
22. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Confidential communication
referring physician
complience
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.
(UR) Utilization review
Specialist
fraud
Protected health information
24. Health Information Portability and Accountability Act
privacy
HIPAA
(ERISA) Employee Retirement Income Security Act of 1974
referring physician
25. 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
privacy
econdary Payer
electronic media
Coordinated Coverage
26. 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
nonprivileged information
Embezzlement
(DRG's)
27. Medical services provided on an outpatient basis
Individually identifiable health information
(APC) Ambulatory Patient Classifications
Amblatory Care
deductible
28. The condition of being secluded from the presence or view of others.
Beneficiary
Notice of Privacy Practices
privacy
breach of confidential communication
29. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Consent form
(UR) Utilization review
(PEC) Pre-existing condition
Preauthorization
30. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Out of Network (OON)
(DCI) Duplicate Coverage Inquiry
Referral
31. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
attending physician
(DRG's)
Consent form
32. What the insurance company will consider paying for as defined in the contract.
(PCN) Primary Care Network
transaction
referring physician
Covered Expenses
33. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(DME) Durable Medical Equipment
(TPA) Third Party Administrator
Specialist
pcp
34. 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
(PCP) Primary Care Physician
Individually identifiable health information
(COBRA)
premium
35. The maximum amount a plan pays for a covered service
(PCP) Primary Care Physician
Notice of Privacy Practices
preauthorization
Allowed Expenses
36. A health insurance enrollee chooses to see an out of network provider without authorization
authorization form
HIPAA
abuse
self-referral
37. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
ee schedule
Network
Embezzlement
deductible
38. 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
ethics
open panel HMO
pcp
econdary Payer
39. 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.
state preemption
Consent form
benefit period
Privacy officer
40. 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
(DRG's)
Maximum Out Of Pocket
self-referral
(AOB) Assignment of Benefits
41. An intentional misrepresentation of the facts to deceive or mislead another.
Participating Provider
complience
Assignment & Authorization
fraud
42. 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
Out of Network (OON)
premium
covered entity
breach of confidential communication
43. Standards of conduct generally accepted as a moral guide for behavior.
closed panel HMO
epo
ethics
abuse
44. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
Protected health information
Assignment & Authorization
disclosure
45. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
electronic media
ids
(POS) Point-of Service Plan
consulting physician
46. 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
Confidential communication
Out of Network (OON)
(COBRA)
Privacy officer
47. 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)
consulting physician
Consent form
Individually identifiable health information
abuse
48. 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
open panel HMO
covered entity
claim
security officer
49. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Consent form
complience plan
(DRG's)
50. Individually identifiable health information
IIHI
self-referral
econdary Payer
cash flow