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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 amount of actual money available to the medical practice
Covered Expenses
transaction
cash flow
consent
2. 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.
complience plan
transaction
state preemption
(PAC) Pre- Admission Certification
3. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
ee schedule
Embezzlement
Treating or performing physician
referral
4. A structure for classifying outpatient services and procedures for purpose of payment
ids
consulting physician
health care provider
(APC) Ambulatory Patient Classifications
5. 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
Pre-certification
(COB) Coordination of Benefits
(Non-par) Non-Participating Provider
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
crossover claim
subscriber
(PCP) Primary Care Physician
7. 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
Experimental Procedures
(COBRA)
Deductible
transaction
8. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
open panel HMO
consulting physician
preauthorization
Coordinated Coverage
9. 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.
ethics
cash flow
security officer
abuse
10. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
benefit period
security officer
crossover claim
11. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
(OOPs) Out of Pocket Costs/Expenses
ee schedule
clearinghouse
12. 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
nonprivileged information
abuse
deductible
13. 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
(TPA) Third Party Administrator
(EPO) Exclusive Provider Organization
IIHI
14. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
open panel HMO
ethics
Amblatory Care
subscriber
15. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
benefit period
hmo
subscriber
(DCI) Duplicate Coverage Inquiry
16. 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
Individually identifiable health information
ordering physician
Assignment & Authorization
(AOB) Assignment of Benefits
17. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
IIHI
open panel HMO
clearinghouse
18. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
medical foundation
Amblatory Care
ee schedule
Subscriber
19. 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
Privileged information
Participating Provider
HIPAA
(DME) Durable Medical Equipment
20. 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
ee schedule
breach of confidential communication
Open Enrollment
(COBRA)
21. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
Protected health information
(PCN) Primary Care Network
(APC) Ambulatory Patient Classifications
22. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
cash flow
Protected health information
(TPA) Third Party Administrator
Claim
23. 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)
nonprivileged information
(TPA) Third Party Administrator
Consent form
AMA
24. A nonprofit integrated delivery system
(TPA) Third Party Administrator
(PPS) Hospital Impatient Prospective Payment System
Privileged information
medical foundation
25. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
abuse
complience plan
business associate
nonprivileged information
26. Someone who is eligible for or receiving benefits under an insurance policy or plan
(DME) Durable Medical Equipment
Network
Beneficiary
abuse
27. 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
pcp
security officer
state preemption
covered entity
28. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Allowed Expenses
econdary Payer
Referral
state preemption
29. 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
Coordinated Coverage
Embezzlement
Covered Expenses
nonprivileged information
30. Unauthorized release of information
breach of confidential communication
claim
pcp
(Non-par) Non-Participating Provider
31. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
authorization form
(PAC) Pre- Admission Certification
consulting physician
Beneficiary
32. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(EPO) Exclusive Provider Organization
benefit period
Referral
Claim
33. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
AMA
consulting physician
ids
Resonable Charge
34. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
electronic media
e-health information management
Medigap Insurance
35. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
disclosure
abuse
closed panel HMO
Out of Network (OON)
36. 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
Preauthorization
health care provider
deductible
37. Is the provider who renders a service to a patient
Maximum Out Of Pocket
consent
Experimental Procedures
Treating or performing physician
38. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
transaction
Resonable Charge
Amblatory Care
deductible
39. A rule - condition - or requirement
Standard
Confidential communication
Privileged information
business associate
40. A nonprofit integrated delivery system
benefit period
Coordinated Coverage
medical foundation
claim
41. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
Network
cash flow
deductible
42. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
referral
abuse
state preemption
(UCR) Usual - Customary and Reasonable
43. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
(PEC) Pre-existing condition
Amblatory Care
HIPAA
44. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
business associate
pos
security officer
45. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
closed panel HMO
Open Enrollment
Allowed Expenses
46. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
econdary Payer
benefit period
Pre-certification
IIHI
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
claim
Individually identifiable health information
Experimental Procedures
Deductible
48. 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
referring physician
self-referral
e-health information management
Pre-existing Condition Exclusion
49. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Allowed Expenses
(UR) Utilization review
preauthorization
(UCR) Usual - Customary and Reasonable
50. 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.
ids
Notice of Privacy Practices
self-referral
Maximum Out Of Pocket