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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.
If you are not ready to take this test, you can
study here
.
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 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
HIPAA
Participating Provider
Standard
complience plan
2. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(TPA) Third Party Administrator
Open Enrollment
Specialist
transaction
3. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Sub-acute Care
(EPO) Exclusive Provider Organization
privacy
Beneficiary
4. A willful act by an employee of taking possession of an employer's money
Embezzlement
preauthorization
nonprivileged information
business associate
5. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Coordinated Coverage
(Non-par) Non-Participating Provider
attending physician
Claim
6. 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
(APC) Ambulatory Patient Classifications
closed panel HMO
ee schedule
(DME) Durable Medical Equipment
7. 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
disclosure
Security Rule
ethics
8. 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
ids
Medigap Insurance
fraud
9. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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10. 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
(ABN) Advance Beneficiary Notice
Standard
ordering physician
e-health information management
11. Integrating benefits payable under more than one health insurance.
attending physician
ids
medical foundation
Coordinated Coverage
12. An intentional misrepresentation of the facts to deceive or mislead another.
(PAC) Pre- Admission Certification
Assignment & Authorization
fraud
breach of confidential communication
13. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Individually identifiable health information
Treating or performing physician
ordering physician
closed panel HMO
14. Is a provider who sends the patients for testing or treatment
referring physician
disclosure
(OOPs) Out of Pocket Costs/Expenses
Standard
15. Individually identifiable health information
IIHI
premium
pos
Privacy officer
16. 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
Pre-certification
Maximum Out Of Pocket
claim
(DME) Durable Medical Equipment
17. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(AOB) Assignment of Benefits
deductible
(UR) Utilization review
claim
18. 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
Preauthorization
(PAC) Pre- Admission Certification
ppo
Out of Network (OON)
19. 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
Medigap Insurance
Sub-acute Care
Experimental Procedures
20. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
premium
(PAC) Pre- Admission Certification
ppo
abuse
21. Is the provider who renders a service to a patient
Treating or performing physician
Pre-certification
Coordinated Coverage
hmo
22. 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
cash flow
Claim
Standard
authorization form
23. A patient claim is eligible for medicare and medicaid
(PPS) Hospital Impatient Prospective Payment System
(TPA) Third Party Administrator
crossover claim
clearinghouse
24. A rule - condition - or requirement
authorization form
cash flow
Preauthorization
Standard
25. 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
fraud
open panel HMO
(Non-par) Non-Participating Provider
Medigap Insurance
26. 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
Standard
Supplementary Medical Insurance
Resonable Charge
(COBRA)
27. 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
IIHI
Protected health information
(ABN) Advance Beneficiary Notice
benefit period
28. 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
prepaid plan
Covered Expenses
(ERISA) Employee Retirement Income Security Act of 1974
29. 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
epo
Allowed Expenses
Maximum Out Of Pocket
complience
30. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
phantom billing
Medigap Insurance
(UR) Utilization review
Open Enrollment
31. 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.
HIPAA
state preemption
Allowed Expenses
Notice of Privacy Practices
32. 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
Out of Network (OON)
ppo
(ERISA) Employee Retirement Income Security Act of 1974
Security Rule
33. 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.
Protected health information
(ABN) Advance Beneficiary Notice
pcp
Participating Provider
34. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Pre-certification
(TPA) Third Party Administrator
covered entity
Pre-existing Condition Exclusion
35. 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
Privacy officer
breach of confidential communication
electronic media
Sub-acute Care
36. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
(PEC) Pre-existing condition
Sub-acute Care
Preauthorization
37. The maximum amount a plan pays for a covered service
(DME) Durable Medical Equipment
Allowed Expenses
Network
Subscriber
38. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
benefit period
(DME) Durable Medical Equipment
hmo
39. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
abuse
Subscriber
hmo
40. Standards of conduct generally accepted as a moral guide for behavior.
Protected health information
ethics
benefit period
ppo
41. A privileged communication that may be disclosed only with the patient's permission.
prepaid plan
complience plan
Confidential communication
benefit period
42. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Claim
(TPA) Third Party Administrator
Resonable Charge
attending physician
43. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Standard
health care provider
electronic media
Sub-acute Care
44. The period of time that payment for Medicare inpatient hospital benefits are available
ordering physician
Deductible
benefit period
subscriber
45. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
(UCR) Usual - Customary and Reasonable
breach of confidential communication
(COBRA)
46. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Coordinated Coverage
attending physician
transaction
47. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Sub-acute Care
complience
Claim
IIHI
48. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
(APC) Ambulatory Patient Classifications
Maximum Out Of Pocket
breach of confidential communication
49. Verbal or written agreement that gives approval to some action - situation - or statement.
referral
(PPS) Hospital Impatient Prospective Payment System
consent
(PEC) Pre-existing condition
50. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Medigap Insurance
HIPAA
open panel HMO
complience