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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 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
breach of confidential communication
(UR) Utilization review
fraud
2. 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
Confidential communication
Preauthorization
(DCI) Duplicate Coverage Inquiry
(Non-par) Non-Participating Provider
3. The condition of being secluded from the presence or view of others.
Treating or performing physician
prepaid plan
self-referral
privacy
4. Medical staff member who is legally responsible for the care and treatment given to a patient.
complience plan
consent
attending physician
(DOS) Date of Service
5. 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
Pre-existing Condition Exclusion
covered entity
(EPO) Exclusive Provider Organization
state preemption
6. Verbal or written agreement that gives approval to some action - situation - or statement.
claim
nonprivileged information
Standard
consent
7. Individually identifiable health information
(EPO) Exclusive Provider Organization
IIHI
Allowed Expenses
epo
8. The dates of healthcare services were provided to the beneficiary
HIPAA
Claim
(DOS) Date of Service
(APC) Ambulatory Patient Classifications
9. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Assignment & Authorization
disclosure
e-health information management
phantom billing
10. 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
Resonable Charge
epo
crossover claim
subscriber
11. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
(TPA) Third Party Administrator
pos
premium
12. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Out of Network (OON)
(UCR) Usual - Customary and Reasonable
Network
IIHI
13. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
Supplementary Medical Insurance
(UCR) Usual - Customary and Reasonable
prepaid plan
self-referral
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.
security officer
Coordinated Coverage
Treating or performing physician
electronic media
15. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(POS) Point-of Service Plan
consent
Referral
complience plan
16. 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
pos
(PPS) Hospital Impatient Prospective Payment System
Beneficiary
crossover claim
17. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
(PAC) Pre- Admission Certification
(PAC) Pre- Admission Certification
AMA
18. A review of the need for inpatient hospital care - completed before the actual admission
referring physician
(OOPs) Out of Pocket Costs/Expenses
pcp
(PAC) Pre- Admission Certification
19. 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
privacy
pcp
Supplementary Medical Insurance
20. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
ppo
(ERISA) Employee Retirement Income Security Act of 1974
(TPA) Third Party Administrator
21. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
Deductible
HIPAA
Medigap Insurance
22. An organization of provider sites with a contracted relationship that offer services
confidentiality
(ERISA) Employee Retirement Income Security Act of 1974
Privacy officer
ids
23. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Notice of Privacy Practices
(PPS) Hospital Impatient Prospective Payment System
clearinghouse
24. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
Standard
(DOS) Date of Service
Experimental Procedures
(TPA) Third Party Administrator
25. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Treating or performing physician
breach of confidential communication
(AOB) Assignment of Benefits
26. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
covered entity
Pre-certification
Subscriber
referring physician
27. American Medical Association
(DME) Durable Medical Equipment
prepaid plan
Coordinated Coverage
AMA
28. 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
authorization form
etiquette
self-referral
Security Rule
29. 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
Assignment & Authorization
confidentiality
(POS) Point-of Service Plan
Amblatory Care
30. Health Information Portability and Accountability Act
Claim
IIHI
medical foundation
HIPAA
31. 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
referral
claim
(DRG's)
32. 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
nonprivileged information
(DME) Durable Medical Equipment
Individually identifiable health information
medical foundation
33. A structure for classifying outpatient services and procedures for purpose of payment
econdary Payer
(DCI) Duplicate Coverage Inquiry
phantom billing
(APC) Ambulatory Patient Classifications
34. Someone who is eligible for or receiving benefits under an insurance policy or plan
prepaid plan
complience
(EPO) Exclusive Provider Organization
Beneficiary
35. Unauthorized release of information
breach of confidential communication
Assignment & Authorization
(COBRA)
Participating Provider
36. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(EPO) Exclusive Provider Organization
abuse
fraud
Referral
37. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Deductible
Pre-certification
ordering physician
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
Maximum Out Of Pocket
etiquette
Referral
open panel HMO
39. An intentional misrepresentation of the facts to deceive or mislead another.
HIPAA
Notice of Privacy Practices
fraud
Medigap Insurance
40. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
complience
Pre-certification
Subscriber
claim
41. 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
(TPA) Third Party Administrator
(APC) Ambulatory Patient Classifications
Assignment & Authorization
econdary Payer
42. 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
Covered Expenses
(COBRA)
state preemption
43. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(AOB) Assignment of Benefits
(TPA) Third Party Administrator
(Non-par) Non-Participating Provider
subscriber
44. 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.
(TPA) Third Party Administrator
Notice of Privacy Practices
fraud
consulting physician
45. 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
preauthorization
authorization form
(COBRA)
46. 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
(APC) Ambulatory Patient Classifications
preauthorization
(PEC) Pre-existing condition
47. 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)
econdary Payer
(APC) Ambulatory Patient Classifications
referral
48. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Out of Network (OON)
(APC) Ambulatory Patient Classifications
Network
breach of confidential communication
49. 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
Allowed Expenses
ee schedule
health care provider
50. 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
Maximum Out Of Pocket
phantom billing
consulting physician
e-health information management