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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. Is the provider who renders a service to a patient
breach of confidential communication
(PCN) Primary Care Network
Sub-acute Care
Treating or performing physician
2. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
subscriber
ordering physician
(DRG's)
preauthorization
3. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(ERISA) Employee Retirement Income Security Act of 1974
AMA
(OOPs) Out of Pocket Costs/Expenses
ordering physician
4. 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
Coordinated Coverage
(PCN) Primary Care Network
open panel HMO
ethics
5. The maximum amount a plan pays for a covered service
(COB) Coordination of Benefits
business associate
Allowed Expenses
Beneficiary
6. A nonprofit integrated delivery system
(UCR) Usual - Customary and Reasonable
(DME) Durable Medical Equipment
deductible
medical foundation
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.
crossover claim
breach of confidential communication
Privacy officer
(COBRA)
8. 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.
confidentiality
Notice of Privacy Practices
ethics
Participating Provider
9. An organization of provider sites with a contracted relationship that offer services
ids
(DME) Durable Medical Equipment
abuse
Individually identifiable health information
10. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
hmo
nonprivileged information
confidentiality
Standard
11. Someone who is eligible for or receiving benefits under an insurance policy or plan
Experimental Procedures
Beneficiary
(COB) Coordination of Benefits
Assignment & Authorization
12. Individually identifiable health information
e-health information management
Specialist
IIHI
open panel HMO
13. A rule - condition - or requirement
consulting physician
Standard
econdary Payer
AMA
14. 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
(AOB) Assignment of Benefits
referral
(UR) Utilization review
ee schedule
15. An organization of provider sites with a contracted relationship that offer services
Supplementary Medical Insurance
ids
medical foundation
HIPAA
16. Health Information Portability and Accountability Act
Claim
HIPAA
consulting physician
transaction
17. 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
(POS) Point-of Service Plan
Assignment & Authorization
Amblatory Care
referral
18. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
prepaid plan
Deductible
electronic media
Individually identifiable health information
19. The dates of healthcare services were provided to the beneficiary
self-referral
(DOS) Date of Service
attending physician
Confidential communication
20. 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
cash flow
closed panel HMO
authorization form
prepaid plan
21. 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
(PCN) Primary Care Network
Security Rule
covered entity
Experimental Procedures
22. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Confidential communication
Security Rule
complience plan
(ABN) Advance Beneficiary Notice
23. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
business associate
pcp
claim
AMA
24. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
HIPAA
ids
hmo
state preemption
25. 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
(EPO) Exclusive Provider Organization
Resonable Charge
Out of Network (OON)
(POS) Point-of Service Plan
26. 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
closed panel HMO
Out of Network (OON)
Assignment & Authorization
Resonable Charge
27. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
transaction
subscriber
(OOPs) Out of Pocket Costs/Expenses
hmo
28. Individually identifiable health information
IIHI
premium
Preauthorization
ppo
29. A willful act by an employee of taking possession of an employer's money
Embezzlement
confidentiality
(PAC) Pre- Admission Certification
business associate
30. What the insurance company will consider paying for as defined in the contract.
transaction
Covered Expenses
pos
Assignment & Authorization
31. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(AOB) Assignment of Benefits
pos
covered entity
Individually identifiable health information
32. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
Preauthorization
(APC) Ambulatory Patient Classifications
(PEC) Pre-existing condition
33. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
ppo
confidentiality
health care provider
authorization form
34. The condition of being secluded from the presence or view of others.
Allowed Expenses
privacy
Referral
Maximum Out Of Pocket
35. 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
Resonable Charge
(ERISA) Employee Retirement Income Security Act of 1974
health care provider
complience
36. 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
(AOB) Assignment of Benefits
medical foundation
state preemption
covered entity
37. 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
Subscriber
Supplementary Medical Insurance
ordering physician
etiquette
38. 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
Preauthorization
subscriber
clearinghouse
Open Enrollment
39. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(PEC) Pre-existing condition
Pre-certification
Specialist
breach of confidential communication
40. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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41. 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
security officer
referral
(AOB) Assignment of Benefits
42. A health insurance enrollee chooses to see an out of network provider without authorization
ppo
self-referral
Embezzlement
Preauthorization
43. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
consent
cash flow
attending physician
44. 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
(TPA) Third Party Administrator
covered entity
(AOB) Assignment of Benefits
claim
45. 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
consulting physician
phantom billing
Participating Provider
Deductible
46. 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
Embezzlement
(AOB) Assignment of Benefits
pos
Coordinated Coverage
47. The period of time that payment for Medicare inpatient hospital benefits are available
pos
IIHI
benefit period
preauthorization
48. American Medical Association
AMA
(DRG's)
crossover claim
Coordinated Coverage
49. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Covered Expenses
prepaid plan
Participating Provider
Medigap Insurance
50. A monthly fee paid by the insured for specific medical insurance coverage
hmo
premium
Individually identifiable health information
Deductible