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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. 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
Preauthorization
nonprivileged information
(PCP) Primary Care Physician
benefit period
2. 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
prepaid plan
self-referral
Referral
security officer
3. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Coordinated Coverage
Resonable Charge
disclosure
benefit period
4. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Experimental Procedures
ordering physician
breach of confidential communication
closed panel HMO
5. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
security officer
(DRG's)
(OOPs) Out of Pocket Costs/Expenses
deductible
6. The maximum amount a plan pays for a covered service
transaction
Allowed Expenses
open panel HMO
claim
7. 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
medical foundation
pcp
epo
etiquette
8. Standards of conduct generally accepted as a moral guide for behavior.
deductible
pos
ethics
breach of confidential communication
9. Medical services provided on an outpatient basis
open panel HMO
(ABN) Advance Beneficiary Notice
(ERISA) Employee Retirement Income Security Act of 1974
Amblatory Care
10. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
self-referral
Out of Network (OON)
privacy
11. 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
(ABN) Advance Beneficiary Notice
(Non-par) Non-Participating Provider
12. The condition of being secluded from the presence or view of others.
abuse
privacy
(ERISA) Employee Retirement Income Security Act of 1974
consulting physician
13. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
electronic media
self-referral
Notice of Privacy Practices
14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
premium
closed panel HMO
(PEC) Pre-existing condition
15. 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.
confidentiality
(AOB) Assignment of Benefits
clearinghouse
Privacy officer
16. An organization of provider sites with a contracted relationship that offer services
Coordinated Coverage
nonprivileged information
ids
Privacy officer
17. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Claim
health care provider
Coordinated Coverage
preauthorization
18. 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
closed panel HMO
(PCN) Primary Care Network
Security Rule
Covered Expenses
19. 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
covered entity
medical foundation
Privacy officer
Network
20. 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
(COB) Coordination of Benefits
preauthorization
privacy
21. 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.
Privacy officer
Coordinated Coverage
state preemption
Protected health information
22. 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
subscriber
(COBRA)
Preauthorization
(PEC) Pre-existing condition
23. An organization of provider sites with a contracted relationship that offer services
Specialist
Deductible
Confidential communication
ids
24. Individually identifiable health information
IIHI
Standard
(DCI) Duplicate Coverage Inquiry
Network
25. 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.
Embezzlement
security officer
(PPS) Hospital Impatient Prospective Payment System
Security Rule
26. 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
(POS) Point-of Service Plan
Privacy officer
Treating or performing physician
Medigap Insurance
27. Is the provider who renders a service to a patient
Treating or performing physician
(UR) Utilization review
nonprivileged information
referral
28. A patient claim is eligible for medicare and medicaid
ppo
Open Enrollment
crossover claim
Pre-certification
29. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Sub-acute Care
Claim
ids
Individually identifiable health information
30. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Individually identifiable health information
covered entity
e-health information management
(ABN) Advance Beneficiary Notice
31. The transmission of information between two parties to carry out financial or administrative activities related to health care.
ee schedule
transaction
Subscriber
medical foundation
32. 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
Specialist
subscriber
ppo
33. American Medical Association
Supplementary Medical Insurance
state preemption
AMA
open panel HMO
34. 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
Treating or performing physician
(PCN) Primary Care Network
phantom billing
Preauthorization
35. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(PAC) Pre- Admission Certification
(PAC) Pre- Admission Certification
attending physician
36. 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
pcp
subscriber
37. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
(COBRA)
cash flow
Participating Provider
38. Billing for services not performed
phantom billing
Treating or performing physician
(COBRA)
claim
39. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.
state preemption
nonprivileged information
(PEC) Pre-existing condition
business associate
40. 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
ordering physician
closed panel HMO
benefit period
41. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Medigap Insurance
(PEC) Pre-existing condition
(PCP) Primary Care Physician
Coordinated Coverage
42. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
crossover claim
Sub-acute Care
Privileged information
(COBRA)
43. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
epo
nonprivileged information
Specialist
complience
44. 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
ids
(PCP) Primary Care Physician
(PPS) Hospital Impatient Prospective Payment System
(UCR) Usual - Customary and Reasonable
45. 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
Resonable Charge
Beneficiary
complience
46. 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
AMA
Treating or performing physician
nonprivileged information
47. What the insurance company will consider paying for as defined in the contract.
(PPS) Hospital Impatient Prospective Payment System
deductible
Covered Expenses
Notice of Privacy Practices
48. The dates of healthcare services were provided to the beneficiary
ids
(DOS) Date of Service
electronic media
security officer
49. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
security officer
pcp
security officer
Preauthorization
50. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
etiquette
Subscriber
HIPAA