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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. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
premium
preauthorization
Embezzlement
(POS) Point-of Service Plan
2. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(ERISA) Employee Retirement Income Security Act of 1974
Covered Expenses
ethics
(EPO) Exclusive Provider Organization
3. Medicare's method of paying acute care hospitals for inpatient care
(AOB) Assignment of Benefits
abuse
(PPS) Hospital Impatient Prospective Payment System
Resonable Charge
4. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(AOB) Assignment of Benefits
econdary Payer
Covered Expenses
5. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
ee schedule
(AOB) Assignment of Benefits
Treating or performing physician
6. 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
ordering physician
complience plan
etiquette
(PCN) Primary Care Network
7. 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
(DCI) Duplicate Coverage Inquiry
Preauthorization
(PEC) Pre-existing condition
Individually identifiable health information
8. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
IIHI
authorization form
complience
pcp
9. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
attending physician
ids
Network
business associate
10. A list of the amount to be paid by an insurance company for each procedure service
pcp
Coordinated Coverage
Beneficiary
ee schedule
11. 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
Participating Provider
security officer
(UR) Utilization review
(AOB) Assignment of Benefits
12. Unauthorized release of information
breach of confidential communication
e-health information management
hmo
(OOPs) Out of Pocket Costs/Expenses
13. 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
Allowed Expenses
Pre-existing Condition Exclusion
Specialist
Covered Expenses
14. 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
crossover claim
Out of Network (OON)
prepaid plan
(AOB) Assignment of Benefits
15. A patient claim is eligible for medicare and medicaid
subscriber
Supplementary Medical Insurance
Security Rule
crossover claim
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
deductible
Individually identifiable health information
pos
Medigap Insurance
17. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(UR) Utilization review
(DCI) Duplicate Coverage Inquiry
Covered Expenses
(AOB) Assignment of Benefits
18. 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
Security Rule
state preemption
(ERISA) Employee Retirement Income Security Act of 1974
phantom billing
19. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Beneficiary
complience plan
(UCR) Usual - Customary and Reasonable
Pre-existing Condition Exclusion
20. 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
referring physician
Covered Expenses
Specialist
(ABN) Advance Beneficiary Notice
21. The period of time that payment for Medicare inpatient hospital benefits are available
(DME) Durable Medical Equipment
benefit period
(APC) Ambulatory Patient Classifications
econdary Payer
22. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
authorization form
(COB) Coordination of Benefits
electronic media
Amblatory Care
23. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
(UCR) Usual - Customary and Reasonable
disclosure
Experimental Procedures
24. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
open panel HMO
ordering physician
fraud
Consent form
25. A nonprofit integrated delivery system
hmo
medical foundation
(PCN) Primary Care Network
Medigap Insurance
26. Health Information Portability and Accountability Act
(PPS) Hospital Impatient Prospective Payment System
(UCR) Usual - Customary and Reasonable
Pre-existing Condition Exclusion
HIPAA
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
(DCI) Duplicate Coverage Inquiry
HIPAA
Out of Network (OON)
Participating Provider
28. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
e-health information management
Security Rule
consulting physician
deductible
29. 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
Covered Expenses
crossover claim
abuse
30. 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
(PEC) Pre-existing condition
prepaid plan
Assignment & Authorization
(PCN) Primary Care Network
31. What the insurance company will consider paying for as defined in the contract.
complience plan
Covered Expenses
Amblatory Care
state preemption
32. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
epo
Privacy officer
Privacy officer
33. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(PCN) Primary Care Network
ethics
(UCR) Usual - Customary and Reasonable
Subscriber
34. 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
Medigap Insurance
ee schedule
self-referral
epo
35. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Deductible
state preemption
e-health information management
nonprivileged information
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
Privileged information
(PCP) Primary Care Physician
medical foundation
(COBRA)
37. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Subscriber
Individually identifiable health information
deductible
etiquette
38. 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
(Non-par) Non-Participating Provider
Claim
business associate
39. 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
Maximum Out Of Pocket
(OOPs) Out of Pocket Costs/Expenses
(ABN) Advance Beneficiary Notice
(COB) Coordination of Benefits
40. 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
pcp
nonprivileged information
Sub-acute Care
41. Verbal or written agreement that gives approval to some action - situation - or statement.
ppo
consent
referral
Preauthorization
42. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
(AOB) Assignment of Benefits
(UR) Utilization review
premium
43. Someone who is eligible for or receiving benefits under an insurance policy or plan
(ERISA) Employee Retirement Income Security Act of 1974
Beneficiary
(PPS) Hospital Impatient Prospective Payment System
nonprivileged information
44. 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
Sub-acute Care
covered entity
Participating Provider
Pre-certification
45. 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
authorization form
Claim
hmo
(DME) Durable Medical Equipment
46. 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.
Notice of Privacy Practices
business associate
(TPA) Third Party Administrator
(DME) Durable Medical Equipment
47. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
(Non-par) Non-Participating Provider
deductible
authorization form
48. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
subscriber
hmo
Network
Specialist
49. 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.
(OOPs) Out of Pocket Costs/Expenses
Pre-existing Condition Exclusion
state preemption
(COBRA)
50. 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
(UCR) Usual - Customary and Reasonable
(OOPs) Out of Pocket Costs/Expenses
phantom billing