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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. A structure for classifying outpatient services and procedures for purpose of payment
Privacy officer
ids
(APC) Ambulatory Patient Classifications
(UR) Utilization review
2. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
pos
Protected health information
(DCI) Duplicate Coverage Inquiry
AMA
3. 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
Protected health information
open panel HMO
(POS) Point-of Service Plan
(Non-par) Non-Participating Provider
4. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
business associate
(COB) Coordination of Benefits
subscriber
5. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
epo
fraud
Consent form
6. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(COBRA)
Pre-existing Condition Exclusion
deductible
disclosure
7. A list of the amount to be paid by an insurance company for each procedure service
referral
HIPAA
ee schedule
closed panel HMO
8. 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
authorization form
Coordinated Coverage
business associate
Referral
9. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(TPA) Third Party Administrator
Allowed Expenses
Network
breach of confidential communication
10. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.
business associate
Protected health information
(TPA) Third Party Administrator
closed panel HMO
11. 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.
(EPO) Exclusive Provider Organization
nonprivileged information
(PAC) Pre- Admission Certification
Notice of Privacy Practices
12. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
(TPA) Third Party Administrator
Medigap Insurance
Out of Network (OON)
Open Enrollment
13. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Pre-existing Condition Exclusion
disclosure
complience plan
ordering physician
14. 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
closed panel HMO
(PCN) Primary Care Network
business associate
15. A structure for classifying outpatient services and procedures for purpose of payment
fraud
(UR) Utilization review
complience plan
(APC) Ambulatory Patient Classifications
16. 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.
Allowed Expenses
Notice of Privacy Practices
state preemption
Pre-certification
17. A monthly fee paid by the insured for specific medical insurance coverage
Open Enrollment
premium
AMA
self-referral
18. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
attending physician
prepaid plan
(OOPs) Out of Pocket Costs/Expenses
prepaid plan
19. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
complience plan
subscriber
consulting physician
phantom billing
20. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
prepaid plan
Covered Expenses
premium
21. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
AMA
Allowed Expenses
Coordinated Coverage
22. Is a provider who sends the patients for testing or treatment
crossover claim
Medigap Insurance
referring physician
Notice of Privacy Practices
23. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
authorization form
security officer
hmo
e-health information management
24. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Specialist
Referral
(APC) Ambulatory Patient Classifications
state preemption
25. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Medigap Insurance
preauthorization
(DOS) Date of Service
Covered Expenses
26. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
closed panel HMO
(TPA) Third Party Administrator
(PEC) Pre-existing condition
subscriber
27. Health Information Portability and Accountability Act
HIPAA
pos
clearinghouse
complience
28. 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.
premium
attending physician
Privacy officer
IIHI
29. Billing for services not performed
security officer
phantom billing
referral
Confidential communication
30. 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
deductible
Assignment & Authorization
state preemption
(UCR) Usual - Customary and Reasonable
31. 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.
(UR) Utilization review
Assignment & Authorization
Privileged information
disclosure
32. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
(PEC) Pre-existing condition
Deductible
(ABN) Advance Beneficiary Notice
33. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
pcp
hmo
claim
Supplementary Medical Insurance
34. 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
Covered Expenses
Experimental Procedures
(DME) Durable Medical Equipment
electronic media
35. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Pre-existing Condition Exclusion
(PAC) Pre- Admission Certification
Coordinated Coverage
36. 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
(APC) Ambulatory Patient Classifications
Pre-existing Condition Exclusion
Out of Network (OON)
consulting physician
37. The maximum amount a plan pays for a covered service
Referral
Pre-existing Condition Exclusion
nonprivileged information
Allowed Expenses
38. 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
Security Rule
(Non-par) Non-Participating Provider
benefit period
electronic media
39. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
Notice of Privacy Practices
closed panel HMO
(DME) Durable Medical Equipment
40. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
open panel HMO
self-referral
Confidential communication
41. 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.
ee schedule
closed panel HMO
Protected health information
(PPS) Hospital Impatient Prospective Payment System
42. 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
closed panel HMO
(OOPs) Out of Pocket Costs/Expenses
abuse
43. A health insurance enrollee chooses to see an out of network provider without authorization
pcp
etiquette
self-referral
(EPO) Exclusive Provider Organization
44. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
complience plan
(DRG's)
Sub-acute Care
45. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
deductible
(TPA) Third Party Administrator
Confidential communication
state preemption
46. Is the provider who renders a service to a patient
(Non-par) Non-Participating Provider
phantom billing
Preauthorization
Treating or performing physician
47. 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
Maximum Out Of Pocket
consulting physician
Referral
48. 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
health care provider
clearinghouse
clearinghouse
49. 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
Preauthorization
Privileged information
Treating or performing physician
50. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
pos
health care provider
electronic media
ppo
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