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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 maximum amount a plan pays for a covered service
benefit period
etiquette
Allowed Expenses
Beneficiary
2. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Experimental Procedures
deductible
abuse
(PAC) Pre- Admission Certification
3. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Privileged information
privacy
transaction
Preauthorization
4. 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
Security Rule
Sub-acute Care
privacy
hmo
5. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
fraud
Assignment & Authorization
Privileged information
6. Someone who is eligible for or receiving benefits under an insurance policy or plan
(UR) Utilization review
Network
Beneficiary
Covered Expenses
7. Health Information Portability and Accountability Act
Privileged information
Allowed Expenses
(APC) Ambulatory Patient Classifications
HIPAA
8. 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.
ppo
Claim
(DCI) Duplicate Coverage Inquiry
Privacy officer
9. 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
business associate
Open Enrollment
referring physician
Out of Network (OON)
10. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Preauthorization
hmo
Pre-existing Condition Exclusion
Claim
11. 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
complience
(EPO) Exclusive Provider Organization
(PCN) Primary Care Network
ids
12. A willful act by an employee of taking possession of an employer's money
(PEC) Pre-existing condition
Embezzlement
complience plan
Protected health information
13. 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
attending physician
AMA
open panel HMO
14. Is the provider who renders a service to a patient
Treating or performing physician
consulting physician
Privileged information
epo
15. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
(APC) Ambulatory Patient Classifications
pos
Assignment & Authorization
16. A provision that apples when a person is covered under more than one group medical program
Notice of Privacy Practices
consulting physician
(COB) Coordination of Benefits
(UR) Utilization review
17. Health Information Portability and Accountability Act
medical foundation
HIPAA
premium
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.
Individually identifiable health information
preauthorization
ppo
self-referral
19. An organization of provider sites with a contracted relationship that offer services
hmo
self-referral
(DRG's)
ids
20. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
(POS) Point-of Service Plan
pcp
confidentiality
21. A health insurance enrollee chooses to see an out of network provider without authorization
Claim
self-referral
authorization form
(DME) Durable Medical Equipment
22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
prepaid plan
Open Enrollment
abuse
(DRG's)
23. 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
pcp
ppo
benefit period
phantom billing
24. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
Privacy officer
(DCI) Duplicate Coverage Inquiry
consulting physician
25. 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.
state preemption
open panel HMO
Coordinated Coverage
prepaid plan
26. 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
state preemption
covered entity
Protected health information
27. The maximum amount a plan pays for a covered service
Allowed Expenses
Privacy officer
econdary Payer
Preauthorization
28. The amount of actual money available to the medical practice
security officer
prepaid plan
clearinghouse
cash flow
29. 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
health care provider
Resonable Charge
breach of confidential communication
30. Medical staff member who is legally responsible for the care and treatment given to a patient.
referral
attending physician
Out of Network (OON)
Notice of Privacy Practices
31. Unauthorized release of information
nonprivileged information
(PPS) Hospital Impatient Prospective Payment System
deductible
breach of confidential communication
32. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(POS) Point-of Service Plan
Resonable Charge
clearinghouse
pos
33. 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
medical foundation
pos
Open Enrollment
Preauthorization
34. The amount of actual money available to the medical practice
Individually identifiable health information
clearinghouse
cash flow
Standard
35. A monthly fee paid by the insured for specific medical insurance coverage
(PPS) Hospital Impatient Prospective Payment System
Referral
Security Rule
premium
36. American Medical Association
Specialist
breach of confidential communication
confidentiality
AMA
37. 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
ee schedule
Supplementary Medical Insurance
etiquette
(PCN) Primary Care Network
38. Individually identifiable health information
Pre-existing Condition Exclusion
crossover claim
IIHI
(DME) Durable Medical Equipment
39. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Protected health information
epo
covered entity
40. 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
Out of Network (OON)
Security Rule
Protected health information
(PCP) Primary Care Physician
41. 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.
(PPS) Hospital Impatient Prospective Payment System
subscriber
Notice of Privacy Practices
(DME) Durable Medical Equipment
42. Someone who is eligible for or receiving benefits under an insurance policy or plan
hmo
Privacy officer
business associate
Beneficiary
43. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Allowed Expenses
authorization form
consulting physician
44. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
ordering physician
state preemption
Standard
45. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Subscriber
etiquette
(PCP) Primary Care Physician
Network
46. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
claim
disclosure
electronic media
Out of Network (OON)
47. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(OOPs) Out of Pocket Costs/Expenses
(TPA) Third Party Administrator
Amblatory Care
complience plan
48. A nonprofit integrated delivery system
medical foundation
Assignment & Authorization
covered entity
nonprivileged information
49. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Supplementary Medical Insurance
(TPA) Third Party Administrator
Coordinated Coverage
Preauthorization
50. 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
crossover claim
Open Enrollment