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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. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
ids
Open Enrollment
HIPAA
2. 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
health care provider
IIHI
Preauthorization
ppo
3. A rule - condition - or requirement
Standard
(ABN) Advance Beneficiary Notice
(PCN) Primary Care Network
Privacy officer
4. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
security officer
Supplementary Medical Insurance
cash flow
Medigap Insurance
5. 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.
HIPAA
Embezzlement
Notice of Privacy Practices
consulting physician
6. 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
Standard
Embezzlement
pcp
Sub-acute Care
7. Integrating benefits payable under more than one health insurance.
claim
Open Enrollment
Coordinated Coverage
transaction
8. A patient claim is eligible for medicare and medicaid
HIPAA
crossover claim
hmo
ppo
9. 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
(APC) Ambulatory Patient Classifications
nonprivileged information
referring physician
epo
10. 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
covered entity
Network
epo
(PPS) Hospital Impatient Prospective Payment System
11. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Confidential communication
IIHI
(OOPs) Out of Pocket Costs/Expenses
Beneficiary
12. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Covered Expenses
privacy
Referral
Resonable Charge
13. The dates of healthcare services were provided to the beneficiary
Protected health information
attending physician
ppo
(DOS) Date of Service
14. 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.
claim
(PPS) Hospital Impatient Prospective Payment System
security officer
authorization form
15. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
electronic media
Pre-certification
Security Rule
16. American Medical Association
referring physician
complience
(DME) Durable Medical Equipment
AMA
17. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
pcp
nonprivileged information
confidentiality
(PPS) Hospital Impatient Prospective Payment System
18. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
electronic media
Deductible
Standard
19. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Claim
preauthorization
open panel HMO
(AOB) Assignment of Benefits
20. 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
transaction
nonprivileged information
Coordinated Coverage
Subscriber
21. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
consent
Specialist
Out of Network (OON)
22. 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
Covered Expenses
Deductible
state preemption
Out of Network (OON)
23. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
health care provider
AMA
e-health information management
claim
24. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
fraud
consulting physician
open panel HMO
(APC) Ambulatory Patient Classifications
25. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(DCI) Duplicate Coverage Inquiry
(OOPs) Out of Pocket Costs/Expenses
pos
26. A health insurance enrollee chooses to see an out of network provider without authorization
electronic media
Covered Expenses
self-referral
Security Rule
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
(ABN) Advance Beneficiary Notice
confidentiality
deductible
Amblatory Care
28. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(COBRA)
referral
(PPS) Hospital Impatient Prospective Payment System
(Non-par) Non-Participating Provider
29. The condition of being secluded from the presence or view of others.
privacy
Consent form
premium
e-health information management
30. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Medigap Insurance
deductible
HIPAA
(PEC) Pre-existing condition
31. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
state preemption
nonprivileged information
Pre-certification
cash flow
32. 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
open panel HMO
etiquette
Network
econdary Payer
33. A health insurance enrollee chooses to see an out of network provider without authorization
(TPA) Third Party Administrator
self-referral
Confidential communication
(DME) Durable Medical Equipment
34. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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35. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Consent form
hmo
pcp
premium
36. 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)
deductible
business associate
Maximum Out Of Pocket
37. 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
prepaid plan
ids
state preemption
(PCN) Primary Care Network
38. 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
(ABN) Advance Beneficiary Notice
Covered Expenses
complience
39. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Coordinated Coverage
(PCN) Primary Care Network
Referral
fraud
40. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
authorization form
Individually identifiable health information
Assignment & Authorization
41. The amount of actual money available to the medical practice
cash flow
Subscriber
Out of Network (OON)
Privileged information
42. Medical services provided on an outpatient basis
Experimental Procedures
hmo
(PEC) Pre-existing condition
Amblatory Care
43. Is the provider who renders a service to a patient
(APC) Ambulatory Patient Classifications
Treating or performing physician
(EPO) Exclusive Provider Organization
(DME) Durable Medical Equipment
44. What the insurance company will consider paying for as defined in the contract.
Network
(EPO) Exclusive Provider Organization
Pre-existing Condition Exclusion
Covered Expenses
45. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
Consent form
(ABN) Advance Beneficiary Notice
HIPAA
46. 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
consulting physician
Participating Provider
Allowed Expenses
47. 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
open panel HMO
(AOB) Assignment of Benefits
Deductible
Privileged information
48. Unauthorized release of information
Referral
(TPA) Third Party Administrator
ethics
breach of confidential communication
49. 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
e-health information management
Medigap Insurance
Assignment & Authorization
Pre-existing Condition Exclusion
50. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
open panel HMO
(POS) Point-of Service Plan
referring physician
claim