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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Privacy officer
Confidential communication
Referral
disclosure
2. Is a provider who sends the patients for testing or treatment
referring physician
(Non-par) Non-Participating Provider
pcp
Consent form
3. 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.
Covered Expenses
Referral
health care provider
ordering physician
4. 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
consulting physician
(APC) Ambulatory Patient Classifications
(PCP) Primary Care Physician
(DRG's)
5. American Medical Association
AMA
Coordinated Coverage
claim
(POS) Point-of Service Plan
6. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
business associate
authorization form
Claim
Supplementary Medical Insurance
7. The amount of actual money available to the medical practice
Beneficiary
ordering physician
Covered Expenses
cash flow
8. Is a provider who sends the patients for testing or treatment
(APC) Ambulatory Patient Classifications
HIPAA
Covered Expenses
referring physician
9. 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
(POS) Point-of Service Plan
Supplementary Medical Insurance
pos
(DCI) Duplicate Coverage Inquiry
10. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
covered entity
(COBRA)
Individually identifiable health information
11. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Coordinated Coverage
fraud
IIHI
12. 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
(PAC) Pre- Admission Certification
econdary Payer
(COBRA)
(APC) Ambulatory Patient Classifications
13. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
complience
preauthorization
clearinghouse
14. 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
disclosure
(PCP) Primary Care Physician
breach of confidential communication
Security Rule
15. 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
ppo
Open Enrollment
ids
16. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
(PCP) Primary Care Physician
Claim
attending physician
17. 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
nonprivileged information
open panel HMO
crossover claim
open panel HMO
18. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Security Rule
e-health information management
Amblatory Care
epo
19. The dates of healthcare services were provided to the beneficiary
Deductible
disclosure
(UR) Utilization review
(DOS) Date of Service
20. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(UCR) Usual - Customary and Reasonable
(COBRA)
consulting physician
referral
21. An intentional misrepresentation of the facts to deceive or mislead another.
ids
abuse
econdary Payer
fraud
22. 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
(UR) Utilization review
open panel HMO
(PCP) Primary Care Physician
Assignment & Authorization
23. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
crossover claim
Security Rule
HIPAA
(TPA) Third Party Administrator
24. 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
subscriber
Pre-existing Condition Exclusion
referring physician
preauthorization
25. 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
ids
clearinghouse
ids
26. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(PCN) Primary Care Network
(OOPs) Out of Pocket Costs/Expenses
ee schedule
medical foundation
27. 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.
preauthorization
confidentiality
health care provider
Pre-certification
28. The condition of being secluded from the presence or view of others.
security officer
privacy
consent
cash flow
29. Medicare's method of paying acute care hospitals for inpatient care
(TPA) Third Party Administrator
(PPS) Hospital Impatient Prospective Payment System
Privacy officer
e-health information management
30. 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
econdary Payer
(Non-par) Non-Participating Provider
(DME) Durable Medical Equipment
privacy
31. 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
Subscriber
transaction
(PCN) Primary Care Network
(TPA) Third Party Administrator
32. A rule - condition - or requirement
complience
(DME) Durable Medical Equipment
(PCN) Primary Care Network
Standard
33. 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
e-health information management
Preauthorization
Subscriber
prepaid plan
34. A structure for classifying outpatient services and procedures for purpose of payment
(ERISA) Employee Retirement Income Security Act of 1974
ids
(APC) Ambulatory Patient Classifications
Standard
35. 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
Beneficiary
ordering physician
Pre-certification
36. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
referral
Sub-acute Care
referring physician
disclosure
37. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Preauthorization
closed panel HMO
Confidential communication
consulting physician
38. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
transaction
(UR) Utilization review
Privacy officer
pcp
39. The condition of being secluded from the presence or view of others.
(COBRA)
Supplementary Medical Insurance
privacy
business associate
40. Standards of conduct generally accepted as a moral guide for behavior.
Open Enrollment
Privacy officer
claim
ethics
41. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
clearinghouse
complience
referring physician
Subscriber
42. A rule - condition - or requirement
Standard
Resonable Charge
(COBRA)
pos
43. 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.
Privacy officer
Maximum Out Of Pocket
phantom billing
Assignment & Authorization
44. 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.
ee schedule
Preauthorization
Supplementary Medical Insurance
state preemption
45. 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
Privileged information
Standard
pcp
46. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Confidential communication
Referral
prepaid plan
(UCR) Usual - Customary and Reasonable
47. Unauthorized release of information
(ABN) Advance Beneficiary Notice
Open Enrollment
self-referral
breach of confidential communication
48. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
ppo
health care provider
subscriber
Coordinated Coverage
49. Is the provider who renders a service to a patient
Standard
electronic media
Treating or performing physician
econdary Payer
50. 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
clearinghouse
Covered Expenses
Specialist
Out of Network (OON)