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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.
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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. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
self-referral
(ABN) Advance Beneficiary Notice
electronic media
Resonable Charge
2. 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.
etiquette
Privacy officer
ppo
medical foundation
3. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
(EPO) Exclusive Provider Organization
Open Enrollment
(PEC) Pre-existing condition
4. 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
Privileged information
attending physician
econdary Payer
5. Customs - rules of conduct - courtesy - and manners of the medical profession
(ABN) Advance Beneficiary Notice
Privacy officer
etiquette
(TPA) Third Party Administrator
6. 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.
Protected health information
ee schedule
Amblatory Care
(OOPs) Out of Pocket Costs/Expenses
7. 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
covered entity
authorization form
Pre-certification
Security Rule
8. 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)
Consent form
(COBRA)
(OOPs) Out of Pocket Costs/Expenses
Maximum Out Of Pocket
9. 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
abuse
(AOB) Assignment of Benefits
Treating or performing physician
pcp
10. 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
Pre-existing Condition Exclusion
open panel HMO
Notice of Privacy Practices
11. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
ids
(AOB) Assignment of Benefits
(POS) Point-of Service Plan
12. 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) Point-of Service Plan
pos
ethics
(COBRA)
13. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
abuse
authorization form
self-referral
14. American Medical Association
disclosure
cash flow
econdary Payer
AMA
15. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Covered Expenses
Maximum Out Of Pocket
epo
Claim
16. 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
disclosure
Amblatory Care
covered entity
Embezzlement
17. 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
(PAC) Pre- Admission Certification
subscriber
attending physician
18. A nonprofit integrated delivery system
Out of Network (OON)
Assignment & Authorization
authorization form
medical foundation
19. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Resonable Charge
ids
Experimental Procedures
electronic media
20. Health Information Portability and Accountability Act
closed panel HMO
(UR) Utilization review
HIPAA
Preauthorization
21. 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
Specialist
authorization form
Protected health information
(AOB) Assignment of Benefits
22. 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
Protected health information
pos
epo
23. 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
Treating or performing physician
(POS) Point-of Service Plan
electronic media
fraud
24. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(PPS) Hospital Impatient Prospective Payment System
HIPAA
disclosure
Privacy officer
25. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
transaction
referral
breach of confidential communication
Coordinated Coverage
26. 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
(POS) Point-of Service Plan
Coordinated Coverage
disclosure
27. 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
(POS) Point-of Service Plan
fraud
Participating Provider
(PPS) Hospital Impatient Prospective Payment System
28. 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
ethics
Maximum Out Of Pocket
Allowed Expenses
Deductible
29. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Coordinated Coverage
crossover claim
ee schedule
30. Health Information Portability and Accountability Act
clearinghouse
Specialist
ids
HIPAA
31. 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.
HIPAA
Deductible
Privacy officer
Confidential communication
32. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
33. 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
IIHI
abuse
(PCP) Primary Care Physician
nonprivileged information
34. A monthly fee paid by the insured for specific medical insurance coverage
nonprivileged information
security officer
nonprivileged information
premium
35. 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 officer
(UR) Utilization review
(Non-par) Non-Participating Provider
Privileged information
36. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Coordinated Coverage
nonprivileged information
abuse
37. 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
(OOPs) Out of Pocket Costs/Expenses
Standard
Assignment & Authorization
Pre-existing Condition Exclusion
38. 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
(DME) Durable Medical Equipment
(UR) Utilization review
disclosure
Out of Network (OON)
39. 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
IIHI
cash flow
(UR) Utilization review
40. The condition of being secluded from the presence or view of others.
(DCI) Duplicate Coverage Inquiry
(AOB) Assignment of Benefits
(POS) Point-of Service Plan
privacy
41. 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
(PCN) Primary Care Network
deductible
(DME) Durable Medical Equipment
complience
42. 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
Claim
Sub-acute Care
(COB) Coordination of Benefits
Open Enrollment
43. 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.
Amblatory Care
Privileged information
disclosure
Preauthorization
44. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
electronic media
subscriber
(DME) Durable Medical Equipment
ethics
45. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
HIPAA
HIPAA
prepaid plan
46. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
Deductible
Beneficiary
Maximum Out Of Pocket
47. Someone who is eligible for or receiving benefits under an insurance policy or plan
(COBRA)
Resonable Charge
Beneficiary
abuse
48. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Protected health information
(DCI) Duplicate Coverage Inquiry
ppo
Supplementary Medical Insurance
49. 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.
ordering physician
Supplementary Medical Insurance
Beneficiary
health care provider
50. 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
crossover claim
Subscriber
Confidential communication