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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. 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
premium
privacy
(PAC) Pre- Admission Certification
(AOB) Assignment of Benefits
2. 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
Participating Provider
(COB) Coordination of Benefits
ids
(UCR) Usual - Customary and Reasonable
3. 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
(COBRA)
Specialist
Medigap Insurance
(PCN) Primary Care Network
4. The maximum amount a plan pays for a covered service
clearinghouse
preauthorization
(ERISA) Employee Retirement Income Security Act of 1974
Allowed Expenses
5. Billing for services not performed
premium
ppo
Network
phantom billing
6. Unauthorized release of information
Confidential communication
breach of confidential communication
consent
confidentiality
7. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Pre-existing Condition Exclusion
(APC) Ambulatory Patient Classifications
clearinghouse
Subscriber
8. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
(POS) Point-of Service Plan
preauthorization
Security Rule
9. 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
hmo
open panel HMO
Sub-acute Care
Protected health information
10. 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
nonprivileged information
authorization form
etiquette
11. Someone who is eligible for or receiving benefits under an insurance policy or plan
complience plan
Treating or performing physician
Beneficiary
e-health information management
12. The transmission of information between two parties to carry out financial or administrative activities related to health care.
referral
(PPS) Hospital Impatient Prospective Payment System
referral
transaction
13. A privileged communication that may be disclosed only with the patient's permission.
fraud
(TPA) Third Party Administrator
Confidential communication
Protected health information
14. 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
(PCN) Primary Care Network
nonprivileged information
Security Rule
pcp
15. 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
referring physician
Covered Expenses
Consent form
16. Standards of conduct generally accepted as a moral guide for behavior.
Covered Expenses
(DME) Durable Medical Equipment
ethics
IIHI
17. Customs - rules of conduct - courtesy - and manners of the medical profession
Experimental Procedures
(Non-par) Non-Participating Provider
etiquette
preauthorization
18. 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
pos
Experimental Procedures
IIHI
nonprivileged information
19. Is the provider who renders a service to a patient
business associate
HIPAA
Treating or performing physician
Confidential communication
20. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
(ERISA) Employee Retirement Income Security Act of 1974
premium
fraud
Maximum Out Of Pocket
21. 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
(Non-par) Non-Participating Provider
Supplementary Medical Insurance
Coordinated Coverage
Experimental Procedures
22. A provision that apples when a person is covered under more than one group medical program
(DME) Durable Medical Equipment
(COB) Coordination of Benefits
(Non-par) Non-Participating Provider
(POS) Point-of Service Plan
23. The amount of actual money available to the medical practice
confidentiality
cash flow
Coordinated Coverage
subscriber
24. 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
(POS) Point-of Service Plan
Security Rule
(COB) Coordination of Benefits
(Non-par) Non-Participating Provider
25. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
consulting physician
(EPO) Exclusive Provider Organization
(COB) Coordination of Benefits
26. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Individually identifiable health information
Claim
Consent form
Standard
27. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
(COB) Coordination of Benefits
(ERISA) Employee Retirement Income Security Act of 1974
claim
attending physician
28. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
ppo
Treating or performing physician
ee schedule
29. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Open Enrollment
deductible
closed panel HMO
ids
30. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(Non-par) Non-Participating Provider
pcp
(DOS) Date of Service
Pre-existing Condition Exclusion
31. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
Security Rule
Amblatory Care
epo
32. 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)
self-referral
Consent form
Experimental Procedures
Maximum Out Of Pocket
33. An intentional misrepresentation of the facts to deceive or mislead another.
Experimental Procedures
fraud
(DME) Durable Medical Equipment
clearinghouse
34. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
clearinghouse
Individually identifiable health information
(PCP) Primary Care Physician
Subscriber
35. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
Maximum Out Of Pocket
authorization form
privacy
36. Medical staff member who is legally responsible for the care and treatment given to a patient.
Consent form
clearinghouse
privacy
attending physician
37. Medical services provided on an outpatient basis
Amblatory Care
(Non-par) Non-Participating Provider
referral
clearinghouse
38. Health Information Portability and Accountability Act
HIPAA
business associate
pos
(DCI) Duplicate Coverage Inquiry
39. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
(TPA) Third Party Administrator
(PCN) Primary Care Network
Beneficiary
40. 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.
Claim
(ABN) Advance Beneficiary Notice
Referral
Privacy officer
41. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(EPO) Exclusive Provider Organization
(PEC) Pre-existing condition
Specialist
(ABN) Advance Beneficiary Notice
42. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
ee schedule
premium
Medigap Insurance
confidentiality
43. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Assignment & Authorization
Network
Resonable Charge
(UR) Utilization review
44. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(APC) Ambulatory Patient Classifications
pos
Notice of Privacy Practices
Resonable Charge
45. Health Information Portability and Accountability Act
Open Enrollment
HIPAA
Experimental Procedures
Sub-acute Care
46. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Standard
ppo
Medigap Insurance
(DCI) Duplicate Coverage Inquiry
47. 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.
Privileged information
health care provider
phantom billing
Subscriber
48. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(PCN) Primary Care Network
Standard
preauthorization
Embezzlement
49. 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
Confidential communication
econdary Payer
ppo
clearinghouse
50. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Privileged information
(UCR) Usual - Customary and Reasonable
Participating Provider
(EPO) Exclusive Provider Organization